STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft. SUMMARY OF LITERATURE REVIEW: There is no current consensus regarding the optimal material for anterior cervical fusion. MATERIALS AND METHODS: This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage. RESULTS: The VAS of donor site pain was significantly higher in group A than in group B at the final follow-up. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final follow-up. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final follow-up. CONCLUSIONS: Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.
Animals ; Consensus ; Follow-Up Studies ; Humans ; Lordosis ; Retrospective Studies ; Tissue Donors ; Titanium ; Transplants

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the prevalence and associated factors of the concurrent lower thoracic lesions in patients who have a lumbar spine disease, using the extended lumbar MRI. SUMMARY OF LITERATURE REVIEW: There are no studies regarding the concurrent thoracic lesions with lumbar disease. MATERIALS AND METHODS: All the patients, who had visited the out-patient department (OPD) of orthopaedic surgery in our hospital and underwent lumbar spine MRI, were studied during 1 year. Totally, 750 patients were included. The extended lumbar spine MRI contained additional extended T2-weighted sagittal images that cover the lower thoracic vertebrae with 35 centimeters long. We analyzed the highest observable level, characteristics of detected thoracic lesions. Those lesions were classified according to the severity of compression of the spinal cord and investigation for associated factors of patients. Also, the times for additional tests were measured. RESULTS: Additional tests were able to observe up to the 7th thoracic vertebrae. In 257 cases (34.3%), the lower thoracic lesions were detected and increased with aging (p<0.001). A total of 48 patients (6%) had the lesion compressing the spinal cord and 28 patients needed further evaluation for the lower thoracic lesion. Further, 2 cases were treated surgically for lower thoracic lesions. Scanning extra time for additional test were 3 minutes. CONCLUSIONS: The prevalence of lower thoracic lesions accompanied with the lumbar disease was 34% in this study. Therefore, additional extended lumbar spine MRI is needed to check possible concurrent lesions in the lower thoracic spine.
Aging ; Humans ; Outpatients ; Prevalence ; Retrospective Studies ; Spinal Cord ; Spine ; Thoracic Vertebrae

OBJECTIVES: The purpose of this study was to examine the influence of self-esteem and social support on the depression stati of some clinical nurses, and propose basic data for a depression care program. METHODS: Between March 31 and April 5 at 2006, a self-reporting questionnaire survey was administered to 200 nurses at a general hospital located in Gyeonggi-do. The Beck's Depression Inventory (BDI) was used to assess the subjects'depression stati. RESULTS: The average BDI score of the clinical nurses was 8.9+/-7.5, with 59% belonging to the normal category, 28% having mild depressive symptoms, and 13% with a moderate degree of depressive symptoms. The degree of depression was significantly increased in the clinical nurses with a lower self-esteem and less social support. The degree of depression was significantly increased in the clinical nurses with a lower self-esteem and less social support. According to a multivariate regression analysis, a significant association was found between self-esteem and social support in relation to the depression of clinical nurses. The effect of social support was found to not be significant in cases where the self-esteem was high: however, depression was significantly influenced by social support in cases where the self-esteem was low. CONCLUSION: Self-esteem and social support were observed to influence the depression stati of clinical nurses. Therefore, it is suggested that an increase in depression management programs is required to create systematic management to maintain an atmosphere of high self-esteem and close relationships to manage the depression of clinical nurses.
Atmosphere ; Depression* ; Gyeonggi-do ; Hospitals, General ; Questionnaires

BACKGROUND AND PURPOSE: Manganese could be toxic to the human nervous system. Therefore, it is important to detect the over-exposed patients in their early course of intoxication. The aim of this study is to find a valuable methods of clinical examination and applicable parameters for early detection of manganese intoxication. METHODS: we investigated the 35 men who had been exposed to manganese over 5 years. All the subjects were examined and video monitored by three physicians. We separated them into the two groups(Group A: clinically suspicious, Group B: clinically normal) in terms of their motor functions, gait, posture, expression. Motor functions(finger and foot tapping, rapid alternating movement, pegboard exam, writing and walking velocity etc.), MRIs, and biochemical data were measured and compared. RESULTS: No one showed significant effects of manganese intoxication . Also there were no significant differences between the two groups for their biochemical data except for elevated serum Adenosine deaminase(ADA) in clinically suspicious group. But there was a trend that motor functions were decreased especially for the finger and foot tapping, walking velocity and stride, writing velocity. A large number of subjects showed MRI changes in both groups. So MRI is not necessarily correlated with clinical findings and not a specific diagnostic tool for manganese intoxication but a sensitive one for the exposed subjects to manganese. CONCLUSION: From this study, the decreased motor functions were the only clinically significant neurologic manifestation in those who over-exposed subjects to manganese. The level of serum ADA and brain MRI could be a helpful supportive diagnostic tools for the over-exposure. Even if the subjects with these positive results do not show any significant sign of intoxication , we ought to modify their working environment to reduce further exposure.
Adenosine ; Brain ; Fingers ; Foot ; Gait ; Humans ; Magnetic Resonance Imaging ; Male ; Manganese* ; Nervous System ; Neurologic Manifestations ; Posture ; Walking ; Writing

PURPOSE: To evaluate the incidence and risk factors associated with osteoarthritis after a reconstruction of the anterior cruciate ligament (ACL) using a patellar tendon autograft after an average follow-up period of more than 10 years. MATERIALS AND METHODS: The study examined 56 cases that were selected from 118 cases who underwent an arthroscopic reconstruction of the ACL using a patella tendon autograft a minimum of 8 years ago and were available for follow up. The mean age at the time of the reconstruction was 31.3 years (19-58 years), and the average follow up period was 10.6 years (8.6-13.8 years). At the last follow up, the presence of osteoarthritis on the weight-bearing antero-posterior and lateral, and Merchant's radiographs, was assessed using the Kellgren and Laurence classification. The correlation between the development of osteoarthritis and the clinical results (Lysholm knee score, Lachman test, Pivot-shift test, return to preinjury activity), the radiological results (anterior laxity, persistent anterior subluxation), the interval from injury to the reconstruction, the patient age at the time of the reconstruction, the presence of an accompanying meniscal injury, and the patient's gender were examined. RESULTS: Among the 56 cases, osteoarthritis was detected in 23 (41%) (grade II, 18 cases; grade III, 5 cases), and in regard to the lesion sites, the medial compartment was detected in all cases, the lateral compartment in 12 cases and the patello-femoral compartment in 11 cases. Among them, 19 cases were accompanied with a meniscal injury (OR, 10.336; p = 0.001), and a significant increase in osteoarthritis was detected in those cases with a interval from the injury to the reconstruction of more than 6 months (OR, 4.611; p=0.030), and in those aged more than 26 years at the time of the reconstruction (OR, 5.038; p=0.023). However, there was no correlation between the development of osteoarthritis and the clinical outcome, radiological anterior laxity and continuous anterior subluxation, and genders (p>0.05). CONCLUSION: Osteoarthritis developed in 41% of cases, and developed more frequently in those cases with an accompanying meniscal injury, older patients at the time of the reconstruction, or in those with a longer interval from the injury to reconstruction.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Autografts* ; Classification ; Follow-Up Studies* ; Humans ; Incidence ; Knee ; Knee Joint ; Osteoarthritis* ; Patellar Ligament* ; Risk Factors ; Weight-Bearing

PURPOSE: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. MATERIALS AND METHODS: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fractures. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. RESULTS: The average postoperative HSS was 88.3 and the average WOMAC score was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. CONCLUSION: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.
Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Extremities ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Groin ; Hip ; Hip Joint ; Humans ; Ontario ; Osteolysis ; Periprosthetic Fractures ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Self-Help Devices ; Tacrine

PURPOSE: To evaluate the clinical and radiographic results of cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae. MATERIALS AND METHODS: Thirty-seven patients of childhood septic hip sequelae that were treated with total hip arthroplasty using cone prosthesis, were evaluated after at least 2 years of follow-up. The average age at the time of the operation was 44 years. The cause of hip infection was pyogenic in 34 cases and tuberculous in 3. The average duration of follow-up was 51 months. RESULTS: The average Harris hip score improved from 45 points preoperatively to 90 points postoperatively. The mean leg length discrepancy decreased from 3.1 cm preoperatively to 0.7cm postoperatively. There was one case of stem subsidence over 5 mm, which didn't progress further. One patient underwent revision for migration of acetabular cup at postoperative 53 months. Postoperative infection occurred in 2 patients at postoperative 6 and 9 months respectively, which were treated by prosthesis removal. Radiolucent line over 2 mm was observed between the bone and stem in 1 case, without any evidence of loosening. CONCLUSION: Cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae resulted in excellent clinical and radiographic outcome.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip* ; Humans ; Leg ; Prostheses and Implants*

A 36-year-old primivida, at 29 weeks of pregnancy with no smoking history, was admitted to the hospital complaining of cough for 3 days. Chest X-rays revealed atelectasis of the right upper lobe, and a transbronchial lung biopsy confirmed primary lung adenocarcinoma. After consulting with obstetricians and neonatologists, we wanted to deliver the child and treat the mother with chemoradiotherapy. But as she was adamantly opposed to treatment until fetal lung maturation was complete, we planned to delay the birth until 34 weeks, deliver the baby by caesarian section, and then treat the mother. However, maternal hypoxia and fetal distress resulted in an emergency delivery at 30 weeks. After delivery, we treated the mother's brain metastases with radiation therapy and systemic cisplatin-pemetrexed, but she deteriorated and expired 95 days after the diagnosis. Lung cancer during pregnancy is a rare disease and raises many medical and ethical issues in deciding the best course of therapy. We describe our clinical approach and review the potentially challenging features of managing a pregnant patient with lung cancer.
Adenocarcinoma ; Adult ; Anoxia ; Biopsy ; Brain ; Chemoradiotherapy ; Child ; Cough ; Emergencies ; Fetal Distress ; Humans ; Lung ; Lung Neoplasms ; Mothers ; Neoplasm Metastasis ; Parturition ; Pregnancy ; Pulmonary Atelectasis ; Rare Diseases ; Smoke ; Smoking ; Thorax

Tracheal chondromas are very rare benign cartilaginous tumors. We present the first case report, to our knowledge, of a tracheal chondroma in Korea. A 73-year-old male was referred to our hospital for a mass in the left lung. Flexible bronchoscopy was performed to evaluate the lung mass and incidentally found a tracheal mass as well. A biopsy and histological examination of the tracheal mass revealed a chondroma.
Aged ; Biopsy ; Bronchoscopy ; Chondroma ; Humans ; Korea ; Lung ; Lung Neoplasms ; Male ; Tracheal Neoplasms

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To evaluated the clinical and radiological effectiveness of sacral alar screws for augmentation of S1 pedicle screws in long-level fusion including L5-S1 segment. SUMMARY OF LITERATURE REVIEW: The fusion rates of lumbosacral junction in long-level fusion are various when S1 pedicle screws are used without augmentation. But, reports of sacral alar screw augmentation are rare. MATERIAL AND METHODS: From 1996 to 2005, 63 patients performed more than two-level fusion including lumbosacral junction were reviewed. 47 patients underwent lumbosacral fusion with S1 pedicle screws only (S1 group), and 16 patients with sacral alar screws augmentation in addition to S1 pedicle screws (S1-2 group). Radiologically, bony union, halo sign, and breakage of implants were evaluated. Clinically, complications associated with screw placement and general complications were evaluated. RESULTS: Bony union was obtained in 56 cases(89%) at postoperative 4.3 months. Nonunion was observed in 7 cases(11%, S1 group:5, S1-2 group:2). Loosening of S1 pedicle screw was observed in 32 cases(89%) of S1 group and in 4 cases(25%) of S1-2 group. It showed statistical significance between two groups. Sacral alar screw loosening occurred in 8 cases(50%) of S1-2 group. Metal breakage was developed in 2 cases of S1 group without nonunion or loosening. Postoperative infection occurred in 7 cases(11%, S1 group:5, S1-2 group:2). CONCLUSIONS: Sacral alar screw augmentation was effective on protecting the loosening of S1 pedicle screw. Additional sacral alar screw can improve the rate of fusion for lumbosacral junction despite no statistical significance.
Humans ; Retrospective Studies ; Succinates