Tarsometatarsal injury has not been paid much attention due to it is unusual frequency. But the cases of tarsometatarsal injuries are on the increase in proportion to the increasing "high energy trauma injury" resulted from the traffic and industrial accidents. The purpose of this study is both assessing the relative effects among clinical results, final radiologic findings, treatment results and symtoms. In view of the results so far achieved from 20 cases of tarsometatarsal fracture dislocation which had been treated at Sung-Ae general hospital from January 1990 to December 1993, the results were as follows: 1. Thirteen cases were treated by open reduction and 3 cases were treated by closed reduction with smooth pins but no reduction loss were experienced. 2. Traumatic arthrosis could be observed in 14 cases but there were no influences on the functional end results. 3. Anatomical results correlated with pain. 4. Anatomical or neraly anatomical reduction was considered as most important factor of prognosis.
Accidents, Occupational ; Dislocations ; Hospitals, General ; Prognosis

Optic neuritis (ON) is an acute or subacute inflammatory or demyelination process affecting the optic nerve. ON can be classified ophthalmologically as retrobulbar neuritis, papillitis, neuroretinitis. Retrobulbar neuritis, in which the optic disc appearance is normal, is the most common type of ON in adults. Multiple sclerosis is the most common cause of ON, but in many cases no apparent etiology is found. Paranasal sinusitis as a cause of ON is rare. Management of retrobulbar neuritis which is combined with paranasal sinusitis is controversial. Recently, we experienced a case of retrobulbar neuritis which was combined with paranasal sinusitis without orbital complication. It was treated by endoscopic sinus surgery and endoscopic optic nerve decompression in addition to intravenous antibiotics and corticosteroids. Visual acuity was improved nearly to a normal state after the treatment. The most possible pathophysiologic mechanism of retrobulbar neuritis may be the direct spread of infection of the sphenoid sinus to the optic nerve.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Decompression* ; Demyelinating Diseases ; Humans ; Multiple Sclerosis ; Optic Nerve* ; Optic Neuritis* ; Orbit ; Papilledema ; Retinitis ; Sinusitis* ; Sphenoid Sinus ; Visual Acuity

An 47-year-old woman presented for a microscopic vascular decompression with facial nerve palsy. Past medical history was noncontributory. There were not abnormal physical or laboratory findings. Oral tracheal intubation with an armored tube was performed without any problems. Anesthesia was maintained uneventfully in spite of a high peak inspiratory airway pressure (28 30 cmH2O). After surgery, she had symptoms of airway obstruction and the endotracheal tube was removed. The removed tube was found to have a protrusion through almost all the length of tube which reduced its internal diameter a half. Finally, in any case of "airway obstruction" in an intubated patient, we should consider mechanical problems. We should keep in mind the presence of an armored endotracheal tube cannot be regarded as a guarantee of a patent airway. We must test not only leakage of the cuff but also passage of the tube prior to usage.
Airway Obstruction ; Anesthesia ; Decompression ; Facial Nerve ; Female ; Humans ; Intubation ; Middle Aged ; Paralysis

No abstract available.
Appendicitis* ; Purpura, Schoenlein-Henoch*

BACKGROUND: This study was planned to evaluate the influence of propranolol and esmolol on cerebral circulation and to estimate clinical implications and usefulness. METHODS: This study was designed to measure vital signs, cerebrospinal fluid pressure, cerebral perfusion pressure and blood flow velocity of common carotid artery. This was measured by Doppler Flowmeter after intravenous administration of propranolol 12.5, 25, 50 microgram/kg (P-12.5, P-25, P-50, respectively), and esmolol 0.5, 1.0, 2.0 mg/kg (E-0.5, E-1.0, E-2.0 group, respectively) at 1 or 2 minute intervals for 14 minutes. RESULTS: In the propranolol group (P-12.5, P-25 and P-50), the systolic blood pressure (SBP) significantly decreased since postinjection 1 minute and this decreased pressure continued throughout the entire experiment. But in esmolol group (E-0.5, E-1.0 and E-2.0), the SBP decreased significantly and rapidly recovered within 4 minutes. Heart rate significantly decreased in the propranolol group and continued throughout the experiment, but in the esmolol group the heart rate decreased and rapidly recovered within 10 minutes. The duration of the decreased heart rate in the esmolol group was shortened by decreasing the dosage. The blood flow velocity of the common carotid artery significantly decreased at 1 to 14 minutes after the injection of propranolol, but in group E-1.0, it was significantly decreased at 1 to 2 minutes, and in group E-2.0 at 1 to 3 minutes. CONCLUSIONS: The esmolol group showed less changes of SBP, heart rate and common carotid artery flow, and shorter duration of effect than the propranolol group. Mean blood pressure, cerebrospinal fluid pressure and cerebral perfusion pressure had no significant differences between propranolol and esmolol groups.
Administration, Intravenous ; Blood Flow Velocity ; Blood Pressure ; Carotid Artery, Common* ; Cerebrospinal Fluid Pressure ; Flowmeters ; Heart Rate ; Perfusion ; Propranolol* ; Rabbits* ; Vital Signs*

BACKGROUND: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. METHODS: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. RESULTS: A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56). CONCLUSIONS: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.
Adult* ; APACHE ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hematologic Neoplasms* ; Hemorrhage ; Humans ; Intensive Care Units ; Intracranial Hemorrhages ; Lung Injury ; Male ; Medical Records ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency* ; Retrospective Studies ; Tertiary Care Centers ; Weaning

Ehlers-Danlos syndrome represents a group of inherited connective tissue disorders characterized by varying degrees of joint laxity, skin fragility and hyperextensibility, and a bleeding tendency. The essential defect is a quantitative deficiency of collagen. At present, 10 clinical forms have been recognized on the basis of extent and severity of the principal features, in combination with other abnormalities and the likely mode of inheritance. Type II Ehlers-Danlos syndrome is characterized by mild skin and joint manifestations, the latter limited to hands and feet, and inherited as an autosomal dominant pattern. We experienced a case of type II Ehlers-Danlos syndrome in 9-year-old girl with easy bruisability, skin hyperelasticity, thin, atrophic and a shiny scar, the so-called cigarette-paper scar on anterior side of lower extremities, and joint hypermobility limited to hand and feet. The diagnosis was made by characteristic clinical features and skin biopsy findings. A brief review of related literature was made.
Biopsy ; Child ; Cicatrix ; Collagen ; Connective Tissue ; Diagnosis ; Ehlers-Danlos Syndrome* ; Female ; Foot ; Hand ; Hemorrhage ; Humans ; Joint Instability ; Joints ; Lower Extremity ; Skin ; Wills

PURPOSE: The purpose of this study was to investigate the feasibility and the optimal conditions of radiofrequency (RF) ablation by using the stent-type electrode upon the saphenous vein of goats for the endovenous treatment of varicose veins. MATERIALS AND METHODS: A self-expandable nitinol stent electrode (6 mm diameter, 2 cm length, cell size; 1.3x2 mm) was designed to expose the distal 1cm segment to allow for contact with the venous wall. The proximal part of the electrode was connected to the RF generator by insulated copper wires located within the stent electode introducer. Initially, to optimize the power setting, ablation of 6 saphenous veins in 3 goats was performed with power settings of 10, 20 and 30 W. Pull back rate of the electrode was 2 and 4 cm/min for each power level, respectively. The goats were sacrificed 4-6 weeks later and histologic examinations of the saphenous veins were done. For the second part of the experiment, RF ablation of 4 saphenous veins from 2 goats was done by applying the optimal power, based upon the first examination; these procedure was performed with variable pull back rates. Again, the goats were sacrificed 1-6 weeks later and histologic examinations were done. RESULTS: Endovenous ablation of the goat saphenous veins at 20 W caused complete obliteration without complication. There was incomplete occlusion at 10 W, and there were vessel perforation, extravasation, and adjacent tissue injury at 30 W. In second part of the study, the complete circumferential obliteration of the vein was demonstrated at a pull back rate of 1 cm/min and 3 cm/min with the power of 20 W. CONCLUSION: The stent-type electrode may be useful in endovenous RF ablation for treatment of varicose veins. For stents with a diameter of 6 mm, the optional combination of 20 W of power with a pull back rate of 1-3 cm/min produced the most favorable results. Further study and clinical investigations are warranted.
Catheter Ablation* ; Cell Size ; Copper ; Electrodes* ; Goats* ; Saphenous Vein ; Stents ; Varicose Veins* ; Veins

PURPOSE: Fitz-Hugh-Curtis (FHC) syndrome is characterized by right upper quadrant pain due to perihepatitis with pelvic inflammatory disease (PID). It is diagnosed by using its typical symptoms, but final diagnosis is made by confirmation of the presence of laparoscopically visualized perihepatic violin string like adhesions. However, laparoscopy is difficult to perform in the emergency department. Recently, on computerized tomography (CT) a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We present a review of a series of 11 cases in female of FHC syndrome diagnosed by CT. METHODS: We reviewed the medical records and the CT findings of 11 cases of FHC syndrome diagnosed during 7 months in the emergency department. The clinico radiologic criteria of our hospital is as follows: First, right upper quadrant pain. Second, linear enhancement of the liver capsule in the contrast enhancement phase of CT. Third, no pathologic findings for the liver, the gallbladder and the biliary tract in CT. RESULTS: Eleven patients were diagnosed during 7 months by using criteria. The mean age was 30.2 (range: 16~46) years. Seven patients had a history of PID within 6 months. Seven of the 9 patients who take a pelvic examination were positive in C. trachomatis PCR (polymerase chain reaction), and another patient had a positive N. gonorrhoeae cervix culture. One patient who showed negative in both the C. trachomatis PCR and the N. gonorrhoeae cervix culture had cultured E. coli in urine and blood culture. CONCLUSION: CT makes easy the previously difficult diagnosis of FHC syndrome in female patients capable of pregnancy with right upper quadrant abdominal pain.
Abdominal Pain ; Biliary Tract ; Cervix Uteri ; Chlamydia trachomatis ; Diagnosis ; Emergency Service, Hospital ; Female ; Gallbladder ; Gynecological Examination ; Humans ; Laparoscopy ; Liver ; Medical Records ; Pelvic Inflammatory Disease ; Polymerase Chain Reaction ; Pregnancy ; Tomography, Spiral Computed

BACKGROUND: Low functional nephron mass and graft kidney-recipient body size mismatch can lead to poor graft function. To examine the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on graft function within 5 years post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery in living donor kidney transplantation (LDKT). METHODS: Between February 2004 and November 2013, 142 LDKT recipients without delayed graft function, acute rejection, or infection within 5 years of transplantation were included. The graft function and its relations with graft kidney volume and its weight were analyzed. RESULTS: The graft kidney volume/recipient BSA ratio showed correlation with the estimated glomerular filtration rate (eGFR) of recipients after 3 years post-transplantation. We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of > or =80.4 mL/m2 and those with a ratio of <80.4 mL/m2 (P<0.05). Multivariate analysis showed that the graft kidney volume/recipient BSA ratio, the graft kidney weight/recipient body weight ratio, donor age, donor eGFR, and donor/recipient BSA ratio are independent predictors of graft function at each period of transplantation (P<0.05). CONCLUSIONS: The graft kidney volume of living donors may predict graft function and during living donor and recipient matching, both the potential volume of the donated kidney and the body size of the recipient should be considered.
Body Size ; Body Surface Area ; Body Weight ; Delayed Graft Function ; Glomerular Filtration Rate ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Multivariate Analysis ; Nephrons ; Tissue Donors ; Transplants*