The two-stage exchange arthroplasty (one- or two-stage) is believed to be the gold standard for the management of infections following total knee arthroplasty. We herein report a novel two-stage exchange arthroplasty technique using an antibiotic-impregnated cement intramedullary nail, which can be easily prepared during surgery using a straight thoracic tube and a Steinmann pin, and may provide additional stability to the knee to maintain normal mechanical axis. In addition, there is less pain between the period of prosthesis removal and subsequent reimplantation. Less soft tissue contracture, less scar adhesion, easy removal of the cement intramedullary nail, and successful infection control are the advantages of this technique.
Aged ; Anti-Bacterial Agents/*administration & dosage ; *Arthroplasty, Replacement, Knee ; *Bone Cements ; *Bone Nails ; *Device Removal ; Female ; Gentamicins/administration & dosage ; Humans ; Knee Prosthesis/*adverse effects ; Orthopedic Procedures/methods ; Prosthesis-Related Infections/*therapy ; Reoperation ; Vancomycin/administration & dosage

Background: and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. Methods: In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. Results: The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). Conclusions The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is known as a maternally inherited mitochondrial disease with a m.3243A>G mutation in the MT-TL1 gene. Here, we report a case of targeted temperature management in a MELAS patient who had a cardiac arrest and severe lactic acidosis after recurrent seizures.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is known as a maternally inherited mitochondrial disease with a m.3243A>G mutation in the MT-TL1 gene. Here, we report a case of targeted temperature management in a MELAS patient who had a cardiac arrest and severe lactic acidosis after recurrent seizures.

PURPOSE: To propose a new, multivariable risk-scoring model for predicting 30-day mortality in individuals underwent repair of abdominal aortic aneurysms (AAA). METHODS: Four hundred eighty-five consecutive patients who underwent AAA repair from January 2000 to December 2010 were included in the study. Univariate and multivariate analyses were performed to evaluate the risk factors, and a risk-scoring model was developed. RESULTS: Multivariate analysis identified three independent preoperative risk factors associated with mortality, and a risk-scoring model was created by assigning an equal value to each factor. The independent predictors were location of the AAA, rupture of AAA, and preoperative pulmonary dysfunction. The multivariable regression model demonstrated moderate discrimination (c statistic, 0.811) and calibration (Hosmer-Lemeshow test, P = 0.793). The observed mortality rate did not differ significantly from that predicted by our risk-scoring model. CONCLUSION: Our risk-scoring model has excellent ability to predict 30-day mortality after AAA repair, and awaits validation in further studies.
Aortic Aneurysm, Abdominal* ; Calibration ; Discrimination (Psychology) ; Endovascular Procedures* ; Humans ; Mortality* ; Multivariate Analysis ; Risk Factors ; Rupture ; Surgical Procedures, Operative ; Treatment Outcome

BACKGROUND: The aims of this study were to develop and internally and externally validate a prognostic model that can predict the benefit and harm of thrombolysis in patients with acute ischemic stroke and that may be used promptly in an emergency setting. METHODS: The data of a consecutive series of patients who were hospitalized to Seoul National University Bundang Hospital within 12 hours of stroke onset between January 2004 and March 2008 and with relevant ischemic lesions on diffusion-weighted MRI were used to develop and internally validate the prognostic model. The external validation was performed using the data of patients from five participating centers of the Clinical Research Center for Stroke that had been collected between April 2008 and September 2009. The score on the modified Rankin Disability Scale at 3 months was selected to determine the efficacy outcome, and the occurrence of symptomatic hemorrhagic transformation was used to evaluate the safety outcome. Prognostic models were constructed with logistic regression, and both internal and external validations were performed. RESULTS: The discriminative abilities of the efficacy model (C statistic=0.880) and the safety prognostic model (C statistic=0.864) were confirmed. External validation of both models revealed remarkably little degradation in the discrimination power (C statistic=0.835 and 0.822 for the efficacy and safety models, respectively). CONCLUSIONS: This study shows that the efficacy and safety prognostic models developed with basic clinical variables were reliably validated with independent data. Both models may be helpful to clinicians in the emergency setting to identify patients who would benefit from thrombolysis.
Discrimination (Psychology) ; Emergencies ; Humans ; Logistic Models ; Stroke

OBJECTIVE: The purpose of this study was to clarify the pathogenesis of plunging ranulas in regard of the pathway of lesion propagation using CT scans. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 41 patients with plunging ranula. We divided plunging ranulas into two types: type 1 was defined as those directly passing through a defect of the mylohyoid muscle with the presence (type 1A) or absence (type 1B) of the tail sign and type 2 as those through the traditional posterior route along the free edge of the mylohyoid muscle. Images were also analyzed for the extent of the lesion in respect to the spaces involved. As for type 1 lesions, we recorded the location of the defect of the mylohyoid muscle and the position of the sublingual gland in relation to the defect. RESULTS: CT scans demonstrated type 1 lesion in 36 (88%), including type 1A in 14 and type 1B in 22, and type 2 lesion in 5 (12%). Irrespective of the type, the submandibular space was seen to be involved in all cases either alone or in combination with one or more adjacent spaces. Of the 36 patients with type 1 lesions, the anterior one-third was the most common location of the defect of the mylohyoid muscle, seen in 22 patients. The sublingual gland partially herniated in 30 patients. CONCLUSION: Our results suggest that the majority of plunging ranulas take an anterior shortcut through a defect of the mylohyoid muscle.
Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Neck Muscles/pathology/radiography ; Ranula/pathology/*radiography ; Retrospective Studies ; Sublingual Gland/radiography/surgery ; *Tomography, X-Ray Computed ; Young Adult

PURPOSE: Transcatheter arterial chemoembolization (TACE) has been actively performed for the treatment of unresectable or inoperable hepatocellular carcinoma. However, for the patients with treatment failure after TACE, few options are available for salvage. The purpose of this study was to investigate the efficacy of local radiotherapy as a salvage moda- lity for treatment failure after TACE. MATERIALS AND METHODS: From January 1993 to December 1997, 27 patients were included in this study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Childs class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Mean tumor size was 7.2+/- 2.9 cm. Liver cirrhosis was associated in 10 patients. Portal vein thrombosis was presented in 5 patients. Serum alpha-fetoprotein was positive in 8 patients. According to VICC staging, the number of patients in III and IVA were 17 and 10, respectively. Treatment failure to TACE was evaluated by CT scan and angiography. Radiotherapy was given to the field including tumor with generous margin using 10-MV X-ray. Mean tumor dose was 51.8+-7.9 Gy in daily 1.8 Gy fractions. Tumor response was based on CT scans 4~6 weeks following completion of treatment. RESULTS: An objective response was observed in 16 of 24 patients who were possible to be evaluated, giving a response rate of 66.7%. Survival rates after salvage radiotherapy at 1, 2, 3 years were 55.9%, 35.7%, and 21.4%, respectively. The median survival was 14 months. Six patients among responders are surviving at present. Acute toxicity included G1 elevation of AST/ALT in 4 patients, G2 thrombocytopenia in 2, G2 hyperbilirubinemia in 5, and G2 hypoalbuminemia in 3. During follow-up, 4 patients developed ascites. At 6 months after treatment, gastric ulcers and duodenal ulcer were developed in 2 and 1 patient, respectively. CONCLUSION: Local radiotherapy for treatment failure after TACE in hepatocellular carci- noma appears to be a feasible and effective salvage modality. It gives a 66.7% response rate with a median survival of 14 months. Acute toxicity was self-limiting and manageable. Gastric and duodenal ulcer were significant toxicities after treatment. Further studies are required to find optimal methods of radiotherapy to minimize toxicity.
alpha-Fetoproteins ; Angiography ; Ascites ; Carcinoma, Hepatocellular* ; Child ; Duodenal Ulcer ; Follow-Up Studies ; Humans ; Hyperbilirubinemia ; Hypoalbuminemia ; Liver ; Liver Cirrhosis ; Neoplasm Metastasis ; Noma ; Radiotherapy* ; Stomach Ulcer ; Survival Rate ; Thrombocytopenia ; Tomography, X-Ray Computed ; Treatment Failure ; Venous Thrombosis

BACKGROUND: Neurological deterioration following acute lacunar infarction is not uncommon. Its association with poor clinical outcome is well-known, but little is known about what causes it. This study aimed to elucidate whether 3 stigmas of cerebral microangiopathy, a pathogenesis of lacunar infarction, are associated with neurological deterioration in patients with acute lacunar infarction. METHODS: Patients with acute lacunar infarction who were admitted within 24 hours of onset were identified using a prospective stroke registry. Patients who presented neurological deterioration within 7 days of hospitalization (progressive lacune group) were matched to 4 controls (non-progressive lacune group) for 'onset to arrival time'. Three stigmas of cerebral microangiopathy (leukoaraiosis, cerebral microbleeds, and silent lacunes) were measured using initial brain MRI, and their associations with neurological deterioration were analyzed. RESULTS: During 45 months, a total of 23 patients were identified and matched to 80 controls. Simple comparison of 2 groups showed that those 3 stigmas of cerebral microangiopathy were not significantly associated with neurological deterioration. Hyperlipidemia (p=0.18), history of transient ischemic attack or stroke (p=0.01), initial NIH stroke scale (p=0.07), white blood cell counts (p=0.16), and lesion volume (p=0.03) were possibly different (p's<0.2) between 2 groups. Multivariable logistic regression analysis did not reveal any significant association of those 3 stigmas with neurological deterioration, too (all p values>0.5). CONCLUSIONS: This study did not find a relationship between cerebral microangiopathy and neurological deterioration following acute lacunar infarction. The possibility of inadequate power should be noted.
Brain ; Cerebral Small Vessel Diseases ; Hospitalization ; Humans ; Hyperlipidemias ; Ischemic Attack, Transient ; Leukocyte Count ; Logistic Models ; Prospective Studies ; Stroke ; Stroke, Lacunar