The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression.
Aged* ; Arthroscopy ; Decompression* ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Shoulder Joint ; Shoulder Pain ; Shoulder*

PURPOSE: To evaluate the treatment outcome for Type A2 or above intertrochanteric fractures in elderly patients using cementless bipolar hemiarthroplasties incorporating a standard (tapered, rectangular) stem. MATERIALS AND METHODS: We retrospectively reviewed the records of 37 patients who had undergone bipolar hemiarthroplasty between February 2006 and February 2010 in our hospital, and who had received follow up evaluation for more than two years after the surgery. The mean patient age was 73.5 years (range 65-88 years), and 16 patients were male and 21 were female. We evaluated the the results of their treatment by analyzing the operation duration, volume of bleeding, measured results for the recovery of walking capability, and any complications and radiologic findings. RESULTS: The mean operation duration was 75.3 minutes(50-185 minutes). The average total volume of bleeding was of 755.5 cc(75-1,400 cc). Upon the final follow-up visit, 27 patients(72.9%) had recovered more than 80% of their pre-injury Barthel index values(72.8+/-15.1). Complications included one case of deep infection, one case of acetabular erosion, and 3 cases of greater trochanter non-union. There were no cases of revisions due to prosthesis loosening or for other reasons. CONCLUSION: Cementless bipolar hemiarthroplasty using a tapered, rectangular stem is a viable alternative treatment for type A2 intertrochanteric fractures in elderly patients which supports rapid patient mobilization ability.
Aged ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemorrhage ; Hip ; Hip Fractures ; Humans ; Male ; Osteoporosis ; Prosthesis Failure ; Retrospective Studies ; Treatment Outcome ; Walking

The authors report a case of de novo right middle cerebral artery and left anterior cerebral artery aneurysms in a 52-year-old woman, which were documented angiographically 8 years after the initial left middle cerebral artery aneurysm rupture. She had a history of hypertension and had a familial intracranial aneurysm (her sister had a right A2 aneurysm and brother had a right middle cerebral artery bifurcation aneurysm. We conclude that postoperative follow-up cerebrovascular imaging study should be performed periodically with a more frequent cycle, especially in patients with familial intracranial aneurysms to rule out the subsequent development of de novo aneurysms.
Aneurysm ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Intracranial Aneurysm* ; Middle Aged ; Middle Cerebral Artery ; Rupture ; Siblings ; Subarachnoid Hemorrhage

OBJECTIVE: It is well known that hypotension and hypoxia are detrimental secondary brain insults and have deleterious effects on the outcome of patients with severe closed head injuries. We evaluated the effect of hypotension and hypoxia on aneurysmal subarachnoid hemorrhage(SAH). METHODS: We reviewed retrospectively 159 consecutive operated aneurysmal SAH cases. Hypotension and hypoxia were identified during the patients' operation and intensive care unit hospitalization. We analyzed them as four mutually exclusive categories: neither hypotension nor hypoxia(normal), hypotension only, hypoxia only, hypotension and hypoxia combined. The outcome following aneurysmal SAH was determined by the Glasgow outcome scale score and then analyzed. The incidence of occurrence of hydrocephalus and clinical vasospasm were also analyzed. RESULTS: 22 patients(13.8%) experienced hypotension and 16 patients(10.1%) experienced hypoxia and 8 patients(5.0%) experienced both hypotension and hypoxia. The incidence of hydrocephalus in combined category(75.0%) was significantly higher than normal category(14.3%). The incidence of clinical vasospasm in hypotension category(77.3%) and combined category(87.5%) were significantly higher than normal category(38.1%, p<0.05). The outcome of hypotension category and combined category were significantly unfavorable compared with normal category(p<0.05). Furthermore, the impact of hypotensive insult was much greater on good grade Hunt-Hess patients. CONCLUSION: The detrimental secondary brain insults as hypotension and hypoxia occurred not infrequently in aneurysmal SAH patients and had deleterious effects on the outcome of aneurysmal SAH patients. These data suggest that hypotension during critical period in aneurysmal SAH patients should be avoided to improve outcome.
Aneurysm* ; Anoxia* ; Brain ; Critical Period (Psychology) ; Glasgow Outcome Scale ; Head Injuries, Closed ; Hospitalization ; Humans ; Hydrocephalus ; Hypotension* ; Incidence ; Intensive Care Units ; Retrospective Studies ; Subarachnoid Hemorrhage*

Vascular complications related to hip arthroplasty are common, however, total occlusion of a critical artery that threatens survival of an extremity is extremely rare. We report on a patient who had thrombotic arterial occlusions at the iliac and popliteal arteries following hemiarthroplasty of the hip.
Arteries ; Arthroplasty ; Extremities ; Hemiarthroplasty ; Hip ; Humans ; Popliteal Artery

OBJECTIVE Clomiphene citrate is one of the most commonly used drugs in the treatment of infertility, but the pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to its antiestrogenic effect on the endometrium. Endometrial prolactin is considered to be a marker and an inducer of predecidualization that is characteristic of secretory endometrium. The purpose of this study was to evaluate the association of clomiphene citrate and unsatisfactory endometrial differentiation to secretory endometrium by examining the endometrial expression of prolactin in clomiphene citrate-treated infertile women with luteal phase defect. METHODS: The endometrial samples from infertIle women wIth luteal phase defect (n=27) were examined. Five cases during secretory phase and six cases during proliferative phase were obtained by biopsy. Sixteen cases were obtained by biopsy during secretory phase after clomiphene citrate treatment. By immunohistochemical staining for prolactin, all obtained endometrial tissues were examined. The differences in the endometrial expression of prolactin were evaluated between proliferative phase and secretory phase, and between clomiphene citrate treated group and no treatment group during secretory phase. RESULTS: The staining of endometrial prolactin was significantly more intense in the glandular epithelial cells and stromal cells in the secretory endometrium than in the proliferative endometrium. The glandular expression of prolactin in the secretory endometrium was not significantly different between the clomiphene citrate-treated group and no treatment group (p=0.719), but the staining of prolactin in the stromal cells was significantly less intense in the clomiphene citrate-treated group than no treatment group (p=0.019). CONCLUSION: in this investigation, we demonstrated that the endometrial stromal expression of prolactin in the secretory phase was significantly lower in the clomiphene citrate-treated group campared with no treatment group in infertile women with luteal phase defect. And our finding suggests that clomiphene citrate may have an adverse effect on the endometrial predecidualization in infertile women.
Biopsy ; Clomiphene* ; Endometrium ; Epithelial Cells ; Estrogen Receptor Modulators ; Female ; Humans ; Infertility ; Luteal Phase* ; Ovulation ; Pregnancy Rate ; Prolactin* ; Stromal Cells

OBJECTIVE: Carpal tunnel syndrome(CTS) is the most common entrapment neuropathy in the upper extremities. For the surgical treatment of CTS, endoscopic carpal tunnel release(ECTR) has been developed as a minimally invasive method, alternative to the open procedure over the past decade. The authors present clinical experience and surgical outcome of ECTR. METHODS: One hundred cases(34 right, 30 left and 19 bilateral hands) in 81 consecutive patients(mean age: 51.8 years, range: 33-77 years) with electrodiagnostically-proven CTS underwent a single-portal ECTR from January 2001 to December 2002. Preoperative clinical findings and results of electrodiagnostic studies were compared with surgical outcome respectively after 3-month-follow-up period. RESULTS: Among 100 cases 94(94%) were satisfied with complete or significant relief of symptoms and 6(6%) were dissatisfied with partial or no relief of symptoms. Major complications in 2 cases(one with ulnar nerve injury and the other one with ulnar artery laceration), developed in early experience of ECTR and recurrence in 1 case occured. Severity of electrodiagnostic abnormalities were correlated with surgical outcome but there's no statistical significance between them. Severity of clinical findings, age at onset and symptom duration were not correlated with surgical outcome respectively. CONCLUSION: ECTR is effective in relieving symptoms of CTS with a low complication rate after the learning curve period. Thus, ECTR can be the first procedure, alternative to the open surgery as an efficient, minimally invasive surgical technique for CTS.
Carpal Tunnel Syndrome ; Learning Curve ; Recurrence ; Surgical Procedures, Minimally Invasive ; Ulnar Artery ; Ulnar Nerve ; Upper Extremity

Traumatic tricuspid insufficiency(TI) is a relatively uncommon disorder. We experienced a case in which traumatic TI was suspected by history and the diagnosis was confirmed nonivasively by 2-D echocardiography with Doppler technique. Tricuspid valve in this case showed flail anterior leaflet during systole and Doppler echocardiography demonstrated the presence of tricuspid insufficiency.
Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Systole ; Tricuspid Valve

Necrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively. The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.
Emergencies ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Muscles ; Orthopedics ; Rectal Neoplasms ; Thigh

We experienced a case of 63 years old male patient who had synchronous rectus abdominis intramuscular schwannoma and chest wall lipoma. Schwannoma is rare benign tumor which derived from nerve sheath and mainly peripheral nerve of flexor part. The authors report rare synchronous schwannoma and lipoma development.
Humans ; Lipoma* ; Male ; Neurilemmoma* ; Peripheral Nerves ; Rectus Abdominis* ; Thoracic Wall ; Thorax*