BACKGROUND: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. METHODS: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. RESULTS: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. CONCLUSIONS: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.
Allografts* ; California ; Dermis* ; Follow-Up Studies ; Humans* ; Magnetic Resonance Imaging ; Patient Satisfaction ; Postoperative Complications ; Rotator Cuff* ; Shoulder ; Tears* ; Transplants

BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.
Blood Pressure Monitors ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypnotics and Sedatives ; Intubation* ; Intubation, Intratracheal ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Postal Service ; Thiopental

The treatment of subtrochanteric fracture of the femur is one of the most difficult problems. Open reduction and rigid internal fixation is the choice of treatment nowaday. Zickel(1967) reported a new fixation device to treat subtrochanteric fracture of the femur which was designed to provide more rigid fixation in both major fragments, control angulation and rotation, and permit earlier ambulation. The authors reviewed 14 cases of subtrochanteric fracture of the femur which were treated with Zickel-Nail from June, 1979 to November, 1980. The results were obtained as follows: 1. The average age of patients was 44.7 years. 2. In 10 cases without associated injury, parallel-bar walking was possible within postoperative one week. In 8 cases of these, crutch walking with partial weight bearing was possible within postoperative 2 weeks. In others, there were some benifits in bed-side care because of rigid internal fixation which was provided with Zickel-Nail. 3. There were no significant postoperative complicatons except 3 cases of technical error. 4. There was no limb shortening except one case which was old complicated nonunion with severe osteoporosis and had a new fracture during Zickel-Nail procedure. 5. There were no differences in radiological bony union between pathologic fracture and traumatic fracture except one case with liver cell carcinoma of subtrochanteric region of the femur which we could not do follow-up study.
Carcinoma, Hepatocellular ; Extremities ; Femur ; Follow-Up Studies ; Fractures, Spontaneous ; Hip Fractures ; Humans ; Osteoporosis ; Walking ; Weight-Bearing

DSA(Digital Subtractin Angiography) is a valuable diagnostic imaging method in many clinical fields, includingranal-related conditons. Sixty four renal DSA examinations were performed in 59 patients with renal-relateddiseases from Jan. 1984 to Dec. 1985. Summary of these were as follows: 1. Intraarterial (IA)-DSA is performed in6 cases, intravenous(IV)-DSA in 58 cases. In 58 Examinations of IV-DSA, diagnostic image quality is obtained in 51cases(88%). 2. In investigations of a possible renovascular etiology of hypertension, IV-DSA,is a safe, sensitiveand accurate method. On screening for evaluation of renovascular hypertension, RSP should be replaced with IV-DSA,because IV-DSA is moe sensitive and accurate and can detect not only anatomic change of renal arttery but alsofunctional hemodynamic change. 3. IV-DSA is valuable in diseases with morphologic changes of vessels. Incharacterization of a known renal mass, and evaluation of hematuria, suspected aneurym and renal trauma, IV-DSA isvery useful diagnostic imaging modality. 4. In evaluation of potential renal donors, IV-DSA is an accurate andsafe method with 82.4% of accuracy. IV-DSA also is useful in follow-up of allograft recipients. 5. Ininvestigation of diabetic nephropathy, glomerulonephritis, pyelonephritis, IV-DSA is little helpful. 6. Theadvantages of DSA are well known, particularly post-procedure process using computer programs is helpful forobtaining informations of hemodynamic change or time-sequence-curve of density etc. More technical improvementwith this modality is required for improvement of the image quality and resolution. And more accumulation ofclinical experience is required in order to increase the diagnostic accuracy.
Allografts ; Angiography, Digital Subtraction ; Diabetic Nephropathies ; Diagnostic Imaging ; Follow-Up Studies ; Glomerulonephritis ; Hematuria ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Renovascular ; Mass Screening ; Methods ; Pyelonephritis ; Tissue Donors

Wegener's granulomatosis is a disease of unknown etiology that is characterized by the clinicopathologic complex of necrotixing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and variable degrees of small vessel vasculitis. Recently Antineutrophil Cytoplasmic Antibody (ANCA) has been reported to be a highly specific test for the diagnosis of Wegener's granulomatosis. We have experienced a patient of Wegener's granulomatosis in a 11 year old girl who was admitted with complaints f arthralgia, hematuria, convulsion and associated with otitis media and sinusitis. Serologic test of C-ANCA was positive and histologic findings of the kidney showed crescentic glomerulonephritis with sclerosis and surrounding infiltration of multinucleated giant cells. Patient was treated with pulse methylprednisolone without improvement. The clinical course progressed rapidly and expired due to the renal failure, gastrointestinal bleeding and status epilepticus. A brief review of literatures was made.
Antibodies, Antineutrophil Cytoplasmic* ; Arthralgia ; Child ; Diagnosis ; Female ; Giant Cells ; Glomerulonephritis ; Hematuria ; Hemorrhage ; Humans ; Kidney ; Methylprednisolone ; Otitis Media ; Renal Insufficiency ; Respiratory System ; Sclerosis ; Seizures ; Serologic Tests ; Sinusitis ; Status Epilepticus ; Vasculitis ; Wegener Granulomatosis*

Hemophagocytic syndrome has been identified as a benign reactive histocytic proliferation with marked hemophagocytosis and usually associated with systemic viral infection. Recently similar cases that were associated with bacteria have been described. The syndrome is clinically characterized by fever, severe constitutional symptoms, hepatosplenomegaly, lymphadenopathy and laboratory findings of pancytopenia, hemophagocytosis, abnormal liver function test and coagulopathy. The authors experienced a case of bacteria associated hemophagocytic syndrome in a 11-year old girl following Mycoplasma pneumoniae infection. The patient showed characteristic clinical features of hemophagocytic syndrome, peripheral pancytopenia and phagocytized histiocytes in bone marrow. The brief review of the literature was made.
Bacteria* ; Bone Marrow ; Child ; Female ; Fever ; Histiocytes ; Humans ; Liver Function Tests ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic* ; Mycoplasma pneumoniae ; Pancytopenia ; Pneumonia, Mycoplasma

Two strains of vancomycin-resistant Leuconostoc species were isolated from blood cultures in two compromised patients. The isolates produced gas from Lactobacillus MRS booth, hydrolysed esculin, and produced no ammonia from arginine, thus fulfilling the major criteria as Leucorostoc spp. We recommend that clinical laboratories should perform susceptibility test to vancomycin for clinical isolates (especially from cerebrospinal fluid and blood) which resemble streptococci so as not to confuse Leuconostoc spp. with more commonly isolated pathogens such as streptococci.
Ammonia ; Arginine ; Bacteremia* ; Cerebrospinal Fluid ; Esculin ; Humans ; Lactobacillus ; Leuconostoc* ; Vancomycin

The clinicolaboratory findings, cardiac catheterization, and outcome of operation were analyzed in 78 patients with tetralogy of Fallot, which were diagnosed by echocardiography, cardiac catheterization, and a cardiac angiography and confirmed by operation at Dong San Hospital, Keimyung University, during a 4(1/2)-year period from January 1984 to June 1988. The following results were obtained : 1) Out of the 78 cases, 45 were male and 64 were female. 2) The electrocardiogram showed right axis deviation in 71 cases(91%) and right ventricular hypertrophy in 66 cases(84.6%). 3) Chest X-ray revealed that, the cardiothoracic ratio was normal or decreased in 68 cases(87.3%), and cardiac apex elevation was noticed in 57 cases(73%). 4) Pulmonary stenosis were chiefly valvular and infundibular type(53.8%). 5) The associated heart diseases with TOF were patent foramen ovale(64.1%), right sided aortic arch(19.2%), and secundum ASD(10.3%), in that order. 6) There was an intimate correlation between secondary polycythemia and thrombocytopenia. 7) Among the 78 Cases, 73 cases had total correction, 1 case had shunt operation, and 4cases had total correction after shunt operation. The highest mortality rate occurred in the cases of total correction after shunt operation(25%). The cases with a main pulmonary artery size of 1/3 to 2/3 against, the aorta had a higher mortality than the other group, and no cases expired in the group with a ratio of more than 2/3. The overall surgical mortality was 8.9%.
Angiography ; Aorta ; Axis, Cervical Vertebra ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Electrocardiography ; Female ; Heart Diseases ; Humans ; Hypertrophy, Right Ventricular ; Male ; Mortality ; Polycythemia ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Thorax ; Thrombocytopenia

PURPOSE: Bone involvement is known to develop in 40-70Yo of pediatric acute leukemia. We aimed to analyze the clinical course and result of therapy in pediatric acute leukemia with bone involvement. METHODS: Twenty-seven patients diagnosed as pediatric acute leukemia at Dong San Medical Center from Jan. 1996 to Aug. 1998 were evaluated. According to bone X-ray and whole body bone scan, the patients were divided into two groups. RESULTS: Twenty-seven patients were enrolled in this study with 14 patients(52Yo) showing definite bone involvement on simple X-ray or bone scan. Mean age of patients with bone involvement was 5.5 years. Regarding the type of leukemia, 9 patients(64%) were acute lymphocytic leukemia. Ten patients(71%) out of 14 with bone involvement complained of bone pain at the involved bony site. Site of involvement was most frequent in the lower extremity. On simple X-ray, osteolytic lesion was found in 7 patients(50%), diffuse osteopenia in 2 patients(14%) and pathologic fracture in 2 patients(14%). In bone scan, radioactivity was increased in whole cases of patients with bone involvement. Thirteen patients(93%) were completely remitted by chemo-therapy, but, one AML patient died due to induction failure. CONCLUSION: Bone involvement occured in 52% of pediatric acute leukemia. Bone involvement was more frequent in male patients in the lower extremity, and osteolytic lesion was the most frequent finding on simple X-ray. There was no relevence between bone involvement and prognosis. Further study will be needed to evaluate long-term survival and prognosis. (J Korean Pediatr Soc 2000;43:806-813)
Bone Diseases, Metabolic ; Fractures, Spontaneous ; Humans ; Leukemia* ; Lower Extremity ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Radioactivity

A Statistical observations were done on 587 pediatric patients who were diagnosed as having congenital heart disease by cardiac catheterization angiography and operation at Dong San Hospital Keimyung University, during the period of January 1982 to june 1987. The results were as follows 1) Out of 587 patients, 317 cases were male and 276 cases were female. There were female preponderance in atrial septal defect and patent ductus arteriosus, whille in male tetralogy of Fallot, pulmonary stenosis, and ventricular septal defect. 2) The incidence of congenital heart disease were as folliws;ventricular septal defect 35.7% tetralogy of Fallot 17.5%, patient ductus arteriousus 13.9%, arterial septal defect 7.5% and pulmonary stenosis 2.9%. 3) Most of the patients were visited hospital for the first time between the age of 2 and 10 years. 4) Assosiated anomalies of major congenital heart disease were as follows:the most commonly associated anomaly in ventricular septal defect were pulmonary stenosis and patent ductus arteriosus. Pulmonary stenosis was frequently associated with atrial septal defect. Right sided aortic arch and pentalogy were assosiated with tetralogy of Fallot. The mitral regurgitation was associated with patent ductus arteriosus mostly. 5) The overall surgical mortality was 6.8%. The mortality was high in tetralogy of Fallot(16.1%), transposition of great vessels(28.5%).
Angiography ; Aorta, Thoracic ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent ; Female ; Heart Defects, Congenital* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Male ; Mitral Valve Insufficiency ; Mortality ; Pulmonary Valve Stenosis ; Statistics as Topic* ; Tetralogy of Fallot