PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.
Automobiles ; Braces ; Decompression ; Diskectomy ; Dislocations* ; Female ; Gait Disorders, Neurologic ; Head ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pneumonia ; Pressure Ulcer ; Radiculopathy ; Skull ; Spine ; Traction ; Zygapophyseal Joint*

BACKGROUND: Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. METHODS: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. RESULTS: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). CONCLUSIONS: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.
Body Water ; Critical Illness* ; Electric Impedance* ; Humans ; Intensive Care Units ; Male ; Mortality ; Observational Study* ; Prospective Studies* ; Renal Replacement Therapy* ; Survival Rate ; Water

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.
Agar ; Ascites ; Biopsy ; Body Fluids ; Humans ; Klebsiella pneumoniae ; Medical Records ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus

No abstract available.

No abstract available.

No abstract available.
Animals ; Brain* ; Cats* ; Magnetic Resonance Spectroscopy*

A subperiosteal ganglion has been very rarely reported, since Ollier reported first one in 1864. A subperiosteal ganglion is produced by mucoid degeneration and cyst formation within the periosteum, which results in cortical erosion. The characteristic plain radiolographic appearance of irregular cortical erosion and scalloping, with reactive periosteal bone spicules, has been considered pathognomonic of subperiosteal ganglion. Magnetic resonance imaging is performed to further characterize the soft tissue component of the mass. As in our patient, the characteristic signal intensities of magnetic resonance imaging are especially useful in identifying the lesion as a ganglion and in defining the lobular nature and the anatomical extent. We report here the case of a 35-year-old female who had a sudperiosteal ganglion of the distal radius.
Adult ; Female ; Ganglion Cysts* ; Humans ; Magnetic Resonance Imaging ; Pectinidae ; Periosteum ; Radius*

PURPOSE: To assess the utility of shoulder MRI by using ROC (receiver operating characteristic) curve in theevaluation of rotator cuff tear, anterior labral tear, superior labral tear and Hill-Sachs Lesion. MATERIALS AND METHODS: We evaluated 38 arthroscopically confirmed patients who had undergone shoulder MRI. According to thesignal intensity of the rotator cuff, as seen on T2 and proton density imaging, a five-stage grading system wasdevised. Labral tears were graded according to the separation of the labium; this was based on gleaned,morphologic and signal intensity changes of the labrum : six grades of anterior labral tear and three grades ofsuperior labral tear. Hill-sachs lesion was also classified into four grades according to morphologic and signalchanges of the humeral head. These findings were reviewed by two musculoskeletal radiologists and ROC curves andareas under the curve (Az) was abtained. RESULTS: The ratio of area under the curve of rotator cuff tear,anterior labral tear, superior labral tear and Hill-Sachs lesion were 82.4%, 88.%%, 62.4% and 91.3%, respectively. CONCLUSION: The Accuracy of shoulder MRI using ROC curve was relatively high in rotator cuff tear, anteriorlabral tear and Hill-Sachs lesion, but low in superior labral tear.
Humans ; Humeral Head ; Magnetic Resonance Imaging* ; Protons ; ROC Curve* ; Rotator Cuff ; Shoulder*

No abstract available.
Ear* ; Replantation*

The most important basic requirements for successful skin grafting are the accurate approximation of the edge of the skin graft to that of the wound and the application of even pressure to the graft by a carefully designed dressing. Pressure dressing is indicated for the protection of the graft and the prevention of shearing between the graft and its bed. One of the most widely used methods of pressure dressing is tie-over dressing. The traditional technique is based on the application of long silk sutures along the margin of the graft that are tied over bolus of antibiotics oint-impregnated nonadherent fluffed gauze. With the traditional tie-over dressing, it is impossible to inspect the graft bed for possible hematoma and seroma during the application of dressing. So we adopted another modification of the previously described tie-over dressing methods. From January 1997 to July 1997, we had performed 27 skin graft surgeries and 8 subdermal shavings in 35 patients with our new method of tie-over dressing. We can apply even pressure to the grafts by twisting the long silk sutures instead of typing.In comparison with the plethora of devices and techniques described previously in tie-over dressing construction, our technique offers simplicity and reliable fixation of the graft to the bed and allows further adjustment of the dressing by individual tightening of the threads. Other particularly attractive features are the ability to inspect the graft at any time with little difficulty and the reapplicability of tie-over dressing with the remaining long threads if needed.
Anti-Bacterial Agents ; Bandages* ; Hematoma ; Humans ; Seroma ; Silk ; Skin ; Skin Transplantation ; Sutures ; Transplants ; Wounds and Injuries