No abstract available.
Kidney Calculi*

A case of established infected nonunion of femur after open reduction and internal fixation of proximal femoral fracture with plate and screws in a 20-year-old man has been satisfactorily treated with a conventional Kiintscher nail filled with antibiotic laden bone cement in its hollow cavity. Though the removal of plate and screws, wound debridement, insertion of antibiotic laden bone cement bead at the nonunion site with temporary external skeletal fixation and skeletal traction preceded, a rigid fixation by the nail and vancomycin elution from the cement are believed to have contributed for bony union without troublesome complication of infection in this case.
Debridement ; Femoral Fractures ; Femur* ; Fracture Fixation ; Humans ; Traction ; Vancomycin ; Wounds and Injuries ; Young Adult

Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

STUDY DESIGN: This study is a retrospective evaluation of the high lumbar disc herniations. OBJECTIVE: The purposes of this study is to observe the clinical and radiological findings and out-comes of the high lumbar disc herniations, thus providing a guideline for making diagnosis and for proper treatment modality. SUMMARY OF LITERATURE REVIEW: High lumbar disc herniations at the L1 -2, L2-3 and L3-4 levels represent less than 5% of all disc herniations. The location of pain was highly complected. The represented symptoms and signs such as motor, sensory and reflex changes were variable and potentially misleading in suggesting a level of the disc herniation. MATERIAL AND METHODS: Thirty-one patients with high lumbar disc herniations were retrospectively evaluated. Seventeen patients were treated conservatively and fourteen patients underwent surgery. Review of results was undertaken by an independent observer using a proven outcome assessment measure. RESULTS: The incidence of high lumbar disc herniation is 4.7%(L1-2: 13%, L2-3: 29%, L3-4: 58%) with declining frequency as the level ascends. The peak age incidence is 6th decade in male and 5th decade in female. The positive rate of femoral nerve stretching test(74%) is higher than that of straight leg raising test(51%). In fourteen operative cases, the positive rate of straight leg raising test is 86%. The accuracy of MRI findings in predicting the type of herniated disc is 93%. In results of operation thirteen cases showed more than fair grade(93%). CONCLUSION: The age incidence of the high lumbar disc herniation is older than that of the lower lumbar disc herniation. The femoral nerve stretching test is more useful than straight leg raising test in making diagnosis of high lumbar disc herniations. The prognosis after treatment is comparable with high lumbar disc herniations.
Diagnosis ; Female ; Femoral Nerve ; Humans ; Incidence ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging ; Male ; Prognosis ; Reflex ; Retrospective Studies

OBJECTIVE: To define the prevalence of thyroid dysfunction and autoantibodies in rheumatoid arthritis(RA). A prospective controlled study was conducted on 62 RA patients and 55 controls with non-inflammatory rheumatic diseases (3 osteoarthritis, 6 fibromyalgia, 4 carpal tunnel syndrome and 42 patients with nonspecific joint pain). All subjects were tested for T3, T4, TSH, FT4, RAIU, rheumatoid factor and ANA. Anti-thyroglobulin (TG) Ab and anti-microsomal (Mic) Ab were assayed using a more sensitive direct assay of RIA and TSH-R Ab (TRAb) using competitive radioimmunoassay. Thyroid dysfunction was observed in 10 RA patients (16.2%) of which 6 patients had hypothyroidism and 4 patients hyperthyroidism, and was significantly more prevalent in RA (p=0.026). Anti-Mic Ab was significantly more prevalent in RA patients. The frequencies of anti-Mic Ab and anti-TG Ab in RA patients were 69.4% and 58.1% (cut-off value was 0.3U/ml), but were 16.1% and 12.9% when those over 10U/ml were calculated. Thyroid dysfunction was not present when either of anti-TG Ab or anti-Mic Ab was below 0.3U/ml. The prevalence of thyroid dysfunction or autoantibodies were not different according to the presence of RF or ANA. CONCLUSION: The prevalence of thyroid dysfunction and autoantibodies were significantly increased in RA patients and the variance of the latter in other reports might be explained at least partially by difference in cut-off values of different methods. Thyroid dysfunction may not develop when either of anti-Mic Ab or anti-TG Ab is below 0.3 U/ml in RA.
Arthritis, Rheumatoid* ; Autoantibodies ; Carpal Tunnel Syndrome ; Fibromyalgia ; Humans ; Hyperthyroidism ; Hypothyroidism ; Joints ; Osteoarthritis ; Prevalence ; Prospective Studies ; Radioimmunoassay ; Rheumatic Diseases ; Rheumatoid Factor ; Thyroid Gland*

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

Purpose: We report a case of iatrogenic Horner’s syndrome developing after robot-assisted transaxillary total thyroidectomy.Case summary: A 31-year-old female with right-eye ptosis was referred to our clinic. Three weeks prior, she had undergone robot-assisted total thyroidectomy via the right transaxillary approach to treat right-side thyroid cancer. On ocular examination, the palpebral fissure widths were 5.0 mm in the right lid and 8.0 mm in the left lid, the marginal reflex distances 1, 1.0 mm in the right lid and 4.0 mm in the left lid, and the levator muscle function of both eyes normal. In a dark room, the pupil diameter was 2.5 mm in the right eye and 4.0 mm in the left eye. She did not complain of facial anhidrosis. Thirty minutes after instillation of 0.5% (w/v) apraclonidine into the right eye, the right palpebral fissure width increased from 5.0 to 8.0 mm, and the pupil size from 2.5 to 4.0 mm in the dark. Conclusions Horner’s syndrome can develop after robot-assisted transaxillary total thyroidectomy; patients should be counselled in this regard.

BACKGROUND: As atrial fibrillation occurs in the patients with hypertensive heart disease, the functional abnormalities of heart become more severe and the risk of systemic and cerebral embolization increases. In this study we checked left atrial dimension and other parameters with echocardiography in hypertensive patients with atrial fibrillation. METHODS: In an attempt to define the difference in left atrial dimension and the relation between left atrial size and various echocardiographic parameters, M-mode echocardiography was used to study 63 hypertensive patients, 33 patients with atrial fibrillation, and 30 patients with sinus rhythm. RESULTS: The mean left atrial dimension was 51.7±8.7mm in hypertensive patients with atrial fibrillation versus 39.3±8.4mm in hypertensive patients with sinus rhythm(p < 0.001). In hypertensive patients with atrial fibrillation left atrial dimension was over 50mm in 82%(27 of 33). Left atrial size had positive correlations with end-systolic and -diastolic internal dimension of left ventricle(LV), LV mass and E-point septal separation, and negative correlations with fractional shortening and ejection fraction of LV. CONCLUSION: The echocardiographic measurement of left atrial dimension in patients with hypertension was useful in evaluating the hypertensive heart disease.
Atrial Fibrillation ; Echocardiography ; Heart ; Heart Diseases ; Humans ; Hypertension

Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.
Amputation ; Angiography ; Arteries ; Clinical Study ; Diabetes Mellitus ; Extremities ; Female ; Gangrene ; Humans ; Incidence ; Knee ; Male ; Methods ; Mortality ; Orthopedics ; Prostheses and Implants ; Skin ; Skin Temperature ; Transplants ; Walking ; Weight-Bearing ; Wound Healing

The aim of this investigation was to study the effect of orthodontic force on the flow of gingival crevicular fluid and activities of arylsulfatase and brta-glucuronidase in crevicular fluid. The material consisted of 12 persons between the ages of 13 years and 22 years and all were categorized Class I, 4-4 extraction cases Crevicular fluids were sampled from distal crevis of each canine before treatment (phase 1), after bracketing (phase 2), after application of force (phase 3) and after run out of orthodontic force (phase 4). Crevicular fluid flow did not show any significant changes during the period of treatment. The activities of arylsulfatase increased significantly after setting of orthodontic appliance without application of force, but did not show any significant difference after application of force. The activities of beta-glucuronidase increased significantly after application of orthodontic force and decreased with force deminished. These indicated that beta-glucuronidase was good indicator of bone remodelling resulted from initial orthodontic force.
Gingival Crevicular Fluid* ; Glucuronidase ; Humans ; Orthodontic Appliances