The medial collateral ligament is the most commonly injured ligamentous structure of the knee. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. More recently, many investigators reported that isolated medial collateral ligament injuries did well under non-operative treatment. So, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, meniscal tear and osteochondral lesion is essential. From October 1993 to April 1995, we treated 45 cases of Grade III medial collateral ligament injuries and arthroscopic finding for cruciate ligament, meniscus, bony structure were analized in these cases. The result were as follows; 1. Anterior cruciate ligament injury:37.5% in +1 degree, 42.8% in +2 degree, 86.7% in +3 degree 2. Posterior cruciate ligament injury:12.5% in +1 degree, 13.4% in +2 degree, 33.3% in +3 degree 3. Meniscal injury:12.5% in +1 degree, 21.3% in +2 degree, 33.4% in +3 degree 4. Medial capsular ligament injury was more frequent and severe in the meniscofemoral ligament than in the meniscotibial ligament, but that finding was not correlated with degree of medial instability.
Anterior Cruciate Ligament ; Collateral Ligaments ; Humans ; Knee ; Ligaments ; Posterior Cruciate Ligament ; Research Personnel ; Rupture ; Tears

Interleukin-6(IL-6) is a multifunctional cytokine, and deregulated IL-6 gene expression has been implicated as being involved in the pathogenesis of a number of diseaaes. So we measured the serum level of IL-6 to find a relationahip between uterine cervical cancer and serum IL-6 level. The serum levels of IL-6 were meesured m 54 patients adrnitted to the Severance hospital, from August, 1992 to February, 1993, of whom 27 patients were diagnosed as invasive cancer of cervix, 17 as CIN, and also utilizing 10 patiente diagnosed as uterine myoma as a control group for matched age and parity. The average serum level of IL-6 in invasive cancer, CIN, and uterine myoma were respectively 30.33pg/ml, 37.27pg/ml, and 12.45pg Jml. In 22% af cervical cancer patients (6 of 27), and 27% of CIN patients (4 of 17) studied blood levels of II-6 were detected whereas only 10% of uterine myoma (1 of 10) shorved the same result. However, the difference does not seem to be statistically significant, There was no statistically significant difference among any of the groups, and age and stage did not show any significant cmrelation, and the results need furt,ber investigations.
Cervix Uteri* ; Female ; Gene Expression ; Humans ; Interleukin-6* ; Leiomyoma ; Parity ; Uterine Cervical Neoplasms

OBJECTIVE: The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles. METHODS: There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records. RESULTS: The TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p < 0.01, Fisher's exact test). CONCLUSION: The TAS is a useful tool for differentiating the causality of CSH.
Adult ; Aging ; Craniocerebral Trauma ; Hematoma, Subdural, Chronic* ; Humans ; Insurance ; Intracranial Pressure ; Medical Records ; Precipitating Factors ; Retrospective Studies

OBJECTIVE: Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. METHODS: We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. RESULTS: Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. CONCLUSION: Ethical training and developing decision-making skills are necessary including shared decision making.
Aged* ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Decision Making* ; Humans ; Medical Records ; Missions and Missionaries ; Mortality ; Patient Participation ; Prognosis ; Pupil ; Retrospective Studies

OBJECTIVE: Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively. METHODS: From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes. RESULTS: The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment. CONCLUSION: IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.
Consciousness ; Craniocerebral Trauma ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Headache ; Hematoma, Subdural* ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Symptom Assessment

OBJECTIVE: From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.METHODS: We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".RESULTS: There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.CONCLUSION: Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.
Aneurysm ; Coma ; Decision Making ; Dissent and Disputes ; Education ; Expert Testimony ; Humans ; Insurance ; Intracranial Aneurysm ; Malpractice ; Negotiating ; Rupture ; Seoul

OBJECTIVE: We evaluate the rates and outcomes of major procedure-related complications during coiling. MATERIALS AND METHODS: Between 2007 and 2015, 436 intracranial saccular aneurysms were treated. Complications are categorized as three types: intraprocedural aneurysm rupture (IAR), thromboembolism (TE), and post-procedural early rebleeding (PER). And we evaluated the risk factors of procedure related complications by multivariate analysis. RESULTS: Complications occurred in 61 aneurysms (14%). The overall incidence of complications in subarachnoid hemorrhage (SAH) was significantly higher than in unruptured intracranial aneurysm (UIA) (20% vs. 6%). The incidence of IAR and TE were higher in SAH than in UIA (IAR 12% vs. 4%, TE 7% vs. 3%, p < 0.05). Five PER occurred only in SAH. In 34 UIA which were treated with balloon-assisted coiling (BAC), all these patients had good recovery despite 3 patients had the IAR. The incidence of IAR and TE were not different between BAC and non-BAC groups (p > 0.05). All 7 patients who had IAR during BAC had good recovery. In multiple logistic regression analysis, female gender, SAH, and intraventricular hemorrhage were associated with procedure related complication (p < 0.05). CONCLUSION: Endovascular coil embolization is a minimally invasive procedure, but incidence of its complication is not low, especially in SAH. BAC can be a good tool to avoid poor outcome from unexpected IAR during coiling. While IA tirofiban injection is a useful therapy in TE during coiling, sometimes we are aware of the risk of the early rebleeding in SAH patients.
Aneurysm* ; Embolization, Therapeutic ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Logistic Models ; Multivariate Analysis ; Risk Factors ; Rupture ; Subarachnoid Hemorrhage ; Thromboembolism

There was an error in article.

The purpose of this study was to evaluate the humeral tunnel characters and clinical relevance according to entry point of the humeral tunnel in the baseball players. It was hypothesized that the medial collateral ligament (MCL) reconstruction with nonanatomical starting location of the humeral tunnel (inferior edge of the medial epicondyle: group NA) provided less favorable radiological and clinical outcomes compared to that with anatomical starting location (original footprint of the MCL: group A). The retrospective case review yielded 19 consecutive athletes who underwent isolated MCL reconstruction using the docking technique. Three dimensional-computed tomography scan was performed at 3 months, and the iso-surfacing by marching cubes algorithm were applied to evaluate the length and angle of humeral tunnel. Three outcome measures were used in this study: the visual analog scale for pain, range of motion and the Conway scale. The angle of the humeral tunnel was measured 12.2° (range, 7.9°–25.2°) in the group NA and 15.5° (range, 9.8°–30.4°) in the group A (p<0.05). The mean length of humeral tunnel is measured 16.3 mm (range, 11.7–20.1 mm) in the group NA and 15.2 mm (range, 10.3–19.1 mm) in the group A (p<0.05). MCL reconstruction brought substantial improvement in pain and function. However, between-group comparison revealed no statistical differences in all outcome measurements. The MCL reconstruction using the docking technique provided favorable clinical outcomes in baseball players. Although the humeral tunnel angle and length were different depending on the humeral entry points, clinical differences between the two entry points were not found.
Athletes ; Baseball* ; Collateral Ligaments* ; Humans ; Outcome Assessment (Health Care) ; Range of Motion, Articular ; Retrospective Studies ; Visual Analog Scale

Ganglioneruroblastoma and neuroblastoma are among commonest types of childhood malignancy and a number of unique paraneoplastic syndromes have associated with both localized and disseminated neuroblastoma. The coincidence of neuroblastoma and myoclonic encephalopathy or other paraneoplastic syndromes occurs relatively rare, and therefore, failure to recognize this association could result in delays in both diagnosis and treatment, and the result could prove to be unfortunately fatal. The mechanism which underlies the remote damaging effect of neural crest tumor, especially neuroblastoma, on the nervous system resulting in myoclonic encephalopathy is by no means clear. In addition the nature and the extent of the pathologic lesion are inconsistent. We experienced a case of myoclonic encephalopathy associated with an occult mediastinal ganglioneuroblastoma in a 22-month-old girl who was hospitalized for inability to walk without support and tilting of the head to the left side. She became increasingly ataxic, and during the hospitalization myoclonic jerks of upper extremities and head along with chaotic, rapidly flickering, multidirectional spontaneous eye movements, were noted. Laboratory data included normal complete blood count, urinalysis, BUN and creatinine, electrolytes and bone marrow. Chest X-ray and chest CT revealed a relatively well marginated right posterior mediastinal mass. In a 24 hours urine excretion test, VMA and catecholamines were increased. Over the next 2 weeks, a surgical exploration revealed a right posterior mediastinal mass. Microscopically the mass proved to be a ganglioneuroblastoma, extending to right innominate artery and right axillary lymph nodes. Within 2 weeks after the surgery, radiotherapy (2,400 rads) and chemotherapy (CTX, DTIC, VCR) were started, but corticosteroid was not used. She has been free of tumor and abnormal neurological systemic symptoms and signs for 1 1/2 year since the completion of chemotherapy. In the 3 1/2 years follow-up period, her neurologic symptoms has completely resolved by the completion of 2 years chemotherapy. We report a case of mycoclonic encephalopathy associated with hidden ganglioneuroblastoma in 22-month-old girl.
Blood Cell Count ; Bone Marrow ; Brachiocephalic Trunk ; Catecholamines ; Creatinine ; Dacarbazine ; Diagnosis ; Drug Therapy ; Electrolytes ; Epilepsies, Myoclonic* ; Eye Movements ; Female ; Follow-Up Studies ; Ganglioneuroblastoma* ; Head ; Hospitalization ; Humans ; Infant ; Lymph Nodes ; Myoclonus ; Nervous System ; Neural Crest ; Neuroblastoma ; Neurologic Manifestations ; Paraneoplastic Syndromes* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed ; Upper Extremity ; Urinalysis