PURPOSE: The aims of this study were to evaluate risk factors for knee stiffness after the fixation of distal femoral fractures, and to analyze the clinical and radiologic outcomes. MATERIALS AND METHODS: This is a retrospective case control study of 104 consecutive patients who have a distal femoral fracture and were treated with a submuscular locking plate. The case group comprised of patients with 12-month postoperative range of motion (ROM) ≤90° or a history of manipulation under anesthesia. The case group was compared with the control group of patients with a 12-month postoperative ROM >90°. The possible risk factors were evaluated by univariate and logistic regression analysis. The postoperative ROM and Knee Society clinical rating system was evaluated for the clinical assessment and the distal femoral angle on a whole-extremity scanogram was measured for radiologic assessments. RESULTS: Fifty-four patients were included in the study (14 in the case group, 40 in the control group). Univariate analysis showed that comminuted fracture, intra-articular fracture, open fracture, temporary external fixation, severe osteoarthritis, and prolonged immobilization placed patients at an increased risk for knee stiffness. On the other hand, multivariate logistic regression showed that an extensor mechanism injury was the only significant predictor (p=0.001; odds ratio, 42.0; 95% confidence interval, 5.0–350.7). The ROM and Knee Society score were significantly lower in the case group; however, the coronal alignment was similar in the case and control group. CONCLUSION: Various factors that delay postoperative knee motion place patients at increased risk of knee stiffness. Understanding these risk factors may help surgeons prevent postoperative knee stiffness after distal femoral fractures. In particular, extensor mechanism injury, such as patella fracture or open quadriceps injury, was found to be an independent predictable factor associated with knee stiffness.
Anesthesia ; Bone Plates ; Case-Control Studies ; Femoral Fractures ; Fractures, Comminuted ; Fractures, Open ; Hand ; Humans ; Immobilization ; Intra-Articular Fractures ; Knee ; Logistic Models ; Odds Ratio ; Osteoarthritis ; Patella ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Surgeons

Twenty-five patients with unstable fracture or fracture-dislocation of the thoracolumbar and lumbar spines were treated with Cotrel-Dubousset instrumentation. Internal fixation was done in two ways; long rodding in seventeen patients and short rodding in eight. Short segment posterolateral or posterior autogenous iliac bone graft was done in all cases. The amount of correction of the collapsed anterior vertebral body height and the local kyphotic angle at the immediate post-operation were similar between the two groups, but loss of correction at last follow-up was more severe in the short rodding group. Instrument failure was also more common in the short rodding group. In conclusion, it was found that short segment stabilization of spine fractures with Cotrel-Dubousset instrument can effectively reduce fracture but can not maintain reduction until fusion. Therefore, long rodding was reconfirmed to be the better method of stabilization of the thoracolumbar and lumbar spines fractures.
Body Height ; Follow-Up Studies ; Humans ; Methods ; Spine ; Transplants

Objective: This study compared the epidemiological changes before and after the coronavirus disease 2019 (COVID-19) outbreak in out-of-hospital cardiac arrest patients in a single center. This study analyzed the long-term impact of the COVID-19 pandemic. Methods: Eight hundred and sixty-one out-of-hospital cardiac arrest patients were included in the analysis. Out-of-hospital cardiac arrest patients from January 20, 2018, to January 19, 2020, were used as the control group, and those between January 20, 2020, and January 19, 2022, were used as the study group. The collected data were evaluated using a Student t-test, chi-square test, and logistic regression analysis. Results: During the COVID-19 pandemic, the number of cardiac arrests witnessed at the field level decreased. In the transport stage, mechanical CPR increased and the method for securing the airway had many changes. Transport distances, response times, and on-scene times have increased. Survival discharge from hospital decreased from 9.5% to 5.8% (P=0.045), and good neurological outcomes decreased from 8% to 4% (P=0.017). According to multivariate logistic regression analysis, good neurological outcomes (adjusted odds ratio, 0.299; 95% confidence interval, 0.116-0.772) were significantly lower after the onset of COVID-19. Conclusion With the outbreak of COVID-19, there have been many changes in the pre-hospital stages of out-of-hospital cardiac arrest patients, and the neurological outcomes have also deteriorated. This continued throughout the pandemic period.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most frequent and distressing side effects of surgery, and approximately 50-70% of patients who undergo gynecologic surgery suffer from PONV. In this study, we evaluated the effects of various doses of ramosetron on postoperative nausea and vomiting following gynecologic surgery. METHODS: This study evaluated a randomized placebo-controlled study comprised of 200 patients who underwent gynecologic surgery under general anesthesia. The patients were divided into the following 4 groups; placebo group (saline 4 ml), R15 group (ramosetron 0.15 mg), R30 group (ramosetron 0.3 mg) and R45 group (ramosetron 0.45 mg). Each patient was administered the study drug intravenously at the completion of the operation and the presence and severity of PONV were then evaluated 24 and 48 hours after the operation. RESULTS: The incidence of PONV during the first 24 hours following surgery was lower in patients in the R30 group (44%) than in patients in the placebo group (68%)(P < 0.05). In addition, the incidence of PONV 24 to 48 hours after the operation was lower in patients in the R30 group (12%) and the R45 group (14%) than in patients in the placebo group (44%)(P < 0.05) Moreover, common side effects of 5-HT3 receptor antagonist such as headache, dizziness, and constipation did not develop in any of the groups. CONCLUSIONS: The results of this study indicate that 0.3 mg of ramosetron is the most effective dose for preventing PONV during to the first 48 hours following gynecologic surgery.
Anesthesia, General ; Benzimidazoles ; Constipation ; Dizziness ; Female ; Gynecologic Surgical Procedures ; Headache ; Humans ; Incidence ; Postoperative Nausea and Vomiting ; Receptors, Serotonin, 5-HT3

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.
Arm ; Cerebral Cortex ; Hemorrhage ; Humans ; Hypesthesia ; Internal Capsule ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts ; Stroke*

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.
Amikacin ; Bacteremia ; Bacteria ; Cefotaxime ; Child ; Escherichia coli ; Fever ; Fungi ; Gentamicins ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella ; Neutropenia ; Oxacillin ; Penicillins ; Retrospective Studies ; Shock ; Staphylococcus aureus ; Vancomycin

We treated a 66 year-old-male patient with non-traumatic spontaneous E. coli meningitis, whose cerebrospinal fluid showed turbid, and from which E. coli was cultured, and who had urinary tract infection and fatty liver disease which were thought to be predisposing factors to the meningitis. Gram-negative bacillary meningitis is a very rare condition after the neonatal period, and may be complicated by penetrating cranial injuries, neurosurgical interventions or such debilitating diseases as diabetes, liver cirrhosis, urinary tract infection, malignancy and alcholism, etc. It has a high mortality rate in spite of using various antibiotics.
Adult* ; Anti-Bacterial Agents ; Causality ; Cerebrospinal Fluid ; Fatty Liver ; Humans ; Liver Cirrhosis ; Meningitis* ; Mortality ; Urinary Tract Infections

PURPOSE: The purpose of this study was to investigate the frequency, site and characteristics of motion artifact of ascending aorta mimicking dissection. MATERIALS AND METHODS: The authors evaluated postcontrast CT scans of 60 cases in 60 patients without symptoms of aortic dissection or aortic disease. A Toshiba 900S scanner was used, with 1 cm slice thickness and 1 sec scan time. Streak artifacts, and those relating to extra-aortic vascular structure or pericardial effusion were excluded from this study. RESULTS: Crescent-shaped motion artifacts were seen in 54 cases (90%), and occurred from 1 cm to 4 cm above the level of the aortic valve; between men and women, there was no significant difference in frequency. In each case, the artifact was seen at 1 to 5 (mean 2.9) levels. Its pattern was symmetric in 31 of 60 cases (51%), and at 15 other sites, symmetric artifacts were seen between the SVC and ascending aorta. At the margin of the aortic circumference, the direction of the artifact was left anterior-right posterior in 23.9% of cases, and anterior median-posterior median in 20.8%. CONCLUSION: On CT, motion artifact of ascending aorta occurs frequently. Findings relating to location, symmetric pattern and characteristic direction of artifact may be helpful in the differential diagnosis of aortic dissection and aortic motion artifact.
Aorta* ; Aortic Diseases ; Aortic Valve ; Artifacts* ; Diagnosis, Differential ; Female ; Humans ; Male ; Pericardial Effusion ; Tomography, X-Ray Computed

Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.
Edrophonium* ; Humans ; Muscles ; Myasthenia Gravis*

Repetitive nerve stimulation test(RNS) was performed on 32 patients with myasthenia gravis who showed positive response to the tensilon test. The result of the repetitive stimulation test before and after the tensilon injection was compared with the point of improvement of the CMAP and decremental response. The results were as follows: 1. All patients with myasthenis gravis showed decremental responses to the low rate of stimulation in RNS. 2. The results after tensilon injections showed significant improvements of the CMAP in ocularis oculi(OOC), flexor carpi ulnaris(FCU)(P <0.0005), deltoid and abductor digiti quinti muscles(ADQ)(P < 0.005). 3. There were improvements of decremental responses after tensilon injection. 1) At 2/sec, there were significant improvements in the muscles of ADQ(P <0.005), deltoidl OOC and FCU(P < 0.0005). 2) At 3/sec, there were significant improvements in the muscles of OOC(P <0.005), deltoid, FCU and ADQ(P < 0.0005). 3) At 5/sec, there were also significant improvements in all the muscles of OOC, deltoid, ADQ, FCU(P <0.0005). These results showed that tensilon improves the RNS abnorrnalities in myasthenic patients with positive tensilon test. We think these findings before and after the tensilon injection are helpful to diagnose and differentiate a patient with suspected myasthenia gravis who has a negative tensilon test or insignificant RNS findings.
Edrophonium* ; Humans ; Muscles ; Myasthenia Gravis*