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Congenital diaphragmatic disease is one of the common major congenital anomalies, and its mortality remained still high despite recent medical advances. The aim of this study is to examine the clinical characteristics of congenital diaphragmatic diseases. A total of 39 patients with congenital diaphragmatic disease that underwent surgery from January, 1997 to December, 2009 at Pusan National University Hospital were included in this study. Medical records were retrospectively reviewed. The male to female ratio was 30:9. Six out of 39 cases died (NS) before surgery, 17 patients had Bochdalek's hernia (BH), 11 patients hiatus hernia (HH), 4 diaphragmatic eventration (DE), and 1 Morgagni hernia (MH). There were no differences in mean birth weight and mean gestational age. NS (83.3%). BH (35.3%) was diagnosed more frequently than other diseases in the prenatal period. Three patients (17.6%) of BH expired due to pulmonary hypoplasia and 1 patient had co-existing congenital heart disease. BH was diagnosed more frequently in the prenatal stage and had a higher motality rate than other conditions. Therefore, BH needs to be concentrated more than other anomalies.
Birth Weight ; Diaphragmatic Eventration ; Female ; Gestational Age ; Heart Diseases ; Hernia ; Hernia, Diaphragmatic ; Hernia, Hiatal ; Humans ; Infant ; Infant, Newborn ; Male ; Medical Records ; Retrospective Studies

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.
Appendicitis ; Choristoma ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Intestinal Obstruction ; Laparotomy ; Male ; Meckel Diverticulum* ; Postoperative Complications ; Prevalence ; Sex Ratio ; Vitelline Duct ; Wound Infection

Purpose: To compare the results between plating and intramedullary nailing for ipsilateral fibular fractures in pilon fractures. Materials and Methods: Among 124 patients with pilon fractures from November 2008 to March 2019, 50 patients with a fibular fracture were studied retrospectively and divided into two groups:Group A using a plate and Group B using a Rush pin. The radiological tests confirmed the fracture pat-terns (Rüedi–Allgöwer classification, AO/OTA classification) and evaluated the degree of reduction of fibular and tibial fractures after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) was examined for a clinical evaluation, and the complications were checked. Results: The two groups showed similar distributions in gender, age, injury mechanism, diabetes, smoking, mean follow-up period, Rüedi–Allgöwer classification, AO/OTA classification, and open fracture.The fibular fractures were classified as simple, wedge, multiple, and segmental, showing significant differences between the two groups (p=0.03). There was no difference in the Talocrural angle, Shenton line, and Dime sign. In the reduction of pilon fractures, the appropriate reduction was obtained in 22 cases (88.0%) for both groups. The AOFAS averaged 83.24 in Group A and 80.44 points in Group B, showing no significant difference in complications (nonunion, malunion, infection, and arthritis). Conclusion Regardless of how the fibular fracture was fixed, the reduction of pilon fractures in bothgroups showed good results. Both intramedullary nail and plate fixation could be a suitable fixation method for ipsilateral fibular fractures with a low risk of shortening in pilon fractures.

Purpose: To compare the results between plating and intramedullary nailing for ipsilateral fibular fractures in pilon fractures. Materials and Methods: Among 124 patients with pilon fractures from November 2008 to March 2019, 50 patients with a fibular fracture were studied retrospectively and divided into two groups:Group A using a plate and Group B using a Rush pin. The radiological tests confirmed the fracture pat-terns (Rüedi–Allgöwer classification, AO/OTA classification) and evaluated the degree of reduction of fibular and tibial fractures after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) was examined for a clinical evaluation, and the complications were checked. Results: The two groups showed similar distributions in gender, age, injury mechanism, diabetes, smoking, mean follow-up period, Rüedi–Allgöwer classification, AO/OTA classification, and open fracture.The fibular fractures were classified as simple, wedge, multiple, and segmental, showing significant differences between the two groups (p=0.03). There was no difference in the Talocrural angle, Shenton line, and Dime sign. In the reduction of pilon fractures, the appropriate reduction was obtained in 22 cases (88.0%) for both groups. The AOFAS averaged 83.24 in Group A and 80.44 points in Group B, showing no significant difference in complications (nonunion, malunion, infection, and arthritis). Conclusion Regardless of how the fibular fracture was fixed, the reduction of pilon fractures in bothgroups showed good results. Both intramedullary nail and plate fixation could be a suitable fixation method for ipsilateral fibular fractures with a low risk of shortening in pilon fractures.

Background: Recurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this study, we report 7 cases of recurrent hemarthrosis after TKA in which failure of the initial conservative treatment was followed by angiographic embolization; in 1 of the 7 cases, arthroscopic electrocauterization was also performed after treatment failure with selective embolization. Methods: From January 2015 to May 2018, 7 patients visited our hospital due to recurrent hemarthrosis after TKA. Their medical records and serologic test results were reviewed to check for the presence of any bleeding disorder and history of anticoagulant use. Implant malalignment and instability were checked using X-ray. In all cases, the conservative treatment failed, so interventional angiography with selective embolization was performed, which was also followed by arthroscopic electrocauterization if the outcome was unsatisfactory. Results: The interval between TKA and the onset of hemarthrosis ranged from 3 to 76 months (average, 34.1 months). There was no coagulopathy and instability. All patients underwent conservative treatment at an interval of 4.3 months and the rate of relapse was 3.1 on average. On the interventional angiography, 6 cases showed vascular blush, and 1 case had pulsatile bleeding. The average duration for interventional angiography was 90.9 minutes. The average length of follow-up was 38.8 months. Embolization was successfully performed in 4 cases. In 2 of 3 failed cases, the symptoms improved without further treatment. In the remaining 1 failed case, the patient had a relapse of hemarthrosis, so an arthroscopic procedure was performed, which led to identification of the suspicious bleeding point by using preoperative angiographic findings. Electrocauterization was performed and active bleeding was stopped. All cases with recurrent hemarthrosis achieved improvement. Conclusions Interventional angiography was used to aid in the diagnosis of recurrent hemarthrosis, and therapeutic selective embolization provided satisfactory clinical results. Even if selective embolization fails, interventional angiography may be helpful for further surgical procedures because it reveals vascular blush of a bleeding site. Therefore, interventional angiography and selective embolization should be considered to be a useful treatment for recurrent hemarthrosis after TKA.

Background: Recurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this study, we report 7 cases of recurrent hemarthrosis after TKA in which failure of the initial conservative treatment was followed by angiographic embolization; in 1 of the 7 cases, arthroscopic electrocauterization was also performed after treatment failure with selective embolization. Methods: From January 2015 to May 2018, 7 patients visited our hospital due to recurrent hemarthrosis after TKA. Their medical records and serologic test results were reviewed to check for the presence of any bleeding disorder and history of anticoagulant use. Implant malalignment and instability were checked using X-ray. In all cases, the conservative treatment failed, so interventional angiography with selective embolization was performed, which was also followed by arthroscopic electrocauterization if the outcome was unsatisfactory. Results: The interval between TKA and the onset of hemarthrosis ranged from 3 to 76 months (average, 34.1 months). There was no coagulopathy and instability. All patients underwent conservative treatment at an interval of 4.3 months and the rate of relapse was 3.1 on average. On the interventional angiography, 6 cases showed vascular blush, and 1 case had pulsatile bleeding. The average duration for interventional angiography was 90.9 minutes. The average length of follow-up was 38.8 months. Embolization was successfully performed in 4 cases. In 2 of 3 failed cases, the symptoms improved without further treatment. In the remaining 1 failed case, the patient had a relapse of hemarthrosis, so an arthroscopic procedure was performed, which led to identification of the suspicious bleeding point by using preoperative angiographic findings. Electrocauterization was performed and active bleeding was stopped. All cases with recurrent hemarthrosis achieved improvement. Conclusions Interventional angiography was used to aid in the diagnosis of recurrent hemarthrosis, and therapeutic selective embolization provided satisfactory clinical results. Even if selective embolization fails, interventional angiography may be helpful for further surgical procedures because it reveals vascular blush of a bleeding site. Therefore, interventional angiography and selective embolization should be considered to be a useful treatment for recurrent hemarthrosis after TKA.

Purpose: To evaluate the radiologic and clinical outcomes of a minimally invasive technique using the tarsal sinus approach in the management of Sanders type III, joint depressive type calcaneal fractures. Materials and Methods: Between July 2011 and September 2019, data of 29 patients who underwent a minimally invasive procedure with the sinus tarsi approach for Sanders type III joint depressive intra-articular calcaneal fractures, and were followed up for more than 1 year were analyzed. We evaluated the radiologic outcomes by assessing the radiologic parameters (Böhler angle, Gissane angle, calca-neal length, calcaneal height, calcaneal width). We also evaluated the clinical outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the complications associated with the technique. Results: The radiological results showed an improvement in the Böhler angle from 2.5° to 18.6° and the Gissane angle from 132.4° to 119.1° after the operation. The mean AOFAS score during the clini-cal evaluation was 79.5. We observed 13 cases of posttraumatic arthritis, 1 case of subtalar arthrodesis, and no case of wound complication. Conclusion Minimally invasive technique for Sanders type III joint depressive calcaneal fractures resulted in relatively satisfactory radiologic and clinical outcomes. Open reduction and internal fixation through the sinus tarsi approach reduce complications including wound problems. This approach offers satisfactory results without long-term complications.

Background: This study aims to report the midterm outcomes after surgical treatment of Hawkins Classification III Talar neck fractures. Methods: From March 2010 to April 2022, among a total of 155 patients who visited our hospital with talus fractures, 31 patients underwent surgical treatment for Hawkins classification III talar neck fractures. The inclusion criteria comprised patients with a symptom duration of over 1 year who were available for outpatient follow-up and underwent magnetic resonance imaging (MRI) follow-up 2 months after surgery. Exclusion criteria included patients without preoperative ankle periarticular arthritis, and a total of 27 patients were enrolled. Traffic accidents and falls accounted for 86% of 23 cases, open fractures were 8 cases, and the mean follow-up period was 34.10 months (range, 12–80 months). Clinical outcomes were measured by American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot function index (FFI), and radiological results were obtained using simple radiographs before and after surgery and MRI at 2 months postoperatively to confirm bone union and complications. Results: Complete bone union was achieved in all cases, and the mean duration of union was 4.9 months (range, 4–6 months) and there were no nonunion and varus malunion. At the final follow-up, the mean AOFAS score was 80.18 points (range, 36–90 points) and the mean FFI score was 31.43 points (range, 10–68 points), showing relatively good clinical outcomes. There were 15 cases of avascular necrosis, 6 cases of traumatic arthritis of the ankle joint, 6 cases of irritation of the posterior tibial nerve, and 4 cases of wound problems. Conclusions Hawkins classification III talar neck fractures are mostly caused by high-energy injuries and have a relatively poor prognosis due to the high incidence of complications such as avascular necrosis or posttraumatic arthritis. However, if correct anatomical reduction and rigid internal fixation are performed within a short time after the injury, good results can be expected.

Protective effect of human cerebrospinal fluid antioxidants against enzyme inactivation caused by metal-catalyzed oxidation systems were investigated. When purified glutamine synthetase(GS) was incubated with human cerebrospinal fluid(CSF), the enzyme was progressively inactivated. Catalase and EDTA could inhibit the enzyme inactivation by 50-80%. Small-molecular(Mr<-10,000) fraction of CSF inactivated the exogenous GS, but large-molecular(Mr>-10,000) fraction did not. The GS inactivation by the small-molecular fraction was also markedly inhibited by catalase and EDTA. These results suggested that metal-catalyzed oxidation is involved in the GS inactivation by the small-molecular fraction of CSF. Dithiothreitol(DTT)was shown to inhibit almost completely the oxidative inactivation of GS by CSF. However, DTT inhibited only partially the oxidative inactivation of GS caused by small-molecular fraction of CSF. When large-molecular fraction of CSF was separated by anion-exchange HPLC chromatography, there was a peak of antioxidant activity inhibiting the small-molecular fraction-induced GS inactivation in the presence of DTT. The antioxidant activity was neutralized by monoclonal antibodies to transthyretin. Purified transthyretin was found to efficiently inhibit ascorbate/Cu2+-induced GS inactivation in the presence of DTT. Uric acid and glucose did not shoe any protective effect on the GS inactivation in the same condition. The above results suggest that metal-catalyzed oxidation occurs normally in human CSF, and the transthyretin may play an important role as a CSF antioxidant in protecting proteins from metal-catalyzed oxidation.
Antibodies, Monoclonal ; Antioxidants ; Catalase ; Cerebrospinal Fluid* ; Chromatography ; Chromatography, High Pressure Liquid ; Edetic Acid ; Glucose ; Glutamine ; Humans* ; Prealbumin* ; Shoes ; Uric Acid