A preliminary study was conducted to evaluate the immediate postoperative recovery and socioeconomic efficacy with the surgical release of Carpal tunnel syndrome by double incision technique. Sixty cases of carpal tunnel syndrome were operated by one surgeon between 1993 and 1995 and 44 cases in 39 patients were available for this study. Surgery was done under axillary block and patients were evaiuated preoperatively, 3 weeks and 6 weeks each postoperatively. The evaluation was focused on the immediate recovery in terms of subjective symptoms of pain and paresthesia, local tenderness, strength of grip power and pinch power and postoperative disability. 1l was noted that surgical release of carpal tunnel syndrome utilizing double incision technique was as effective as seen in the endoscopic release in terms of quicker recovery of pain, local tenderness and strength. It was also noted that this double incision technique was as safe and economically beneficial as observed in the conventional open procedure.
Carpal Tunnel Syndrome ; Hand Strength ; Humans ; Paresthesia

We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. The patient was successfully resuscitated through diagnostic angiography with subsequent balloon occlusion and primary repair of the injured subclavian artery. Although pigtail drainage of a pneumothorax is known to be safe and effective, proper insertion and removal techniques should be emphasized to reduce the risk of complications.
Angiography ; Balloon Occlusion ; Catheters* ; Drainage ; Hemothorax ; Humans ; Lacerations* ; Pneumothorax* ; Subclavian Artery* ; Thoracostomy

Inflammatory myofibroblastic tumor(IMT) or inflammatory pseudotumor is a rare, solid tumor that most often affects children. This tumor is characterized by a spindle cell proliferation admixed with a variety of inflammatory cells. Although it has disputed nosology, a distinctive fibroinflammatory and even pseudosarcomatous appearance have been well appreciated. Herein, we report a case of IMT in the posterior mediastinum in a 19-year-old girl with clinical findings. The immunohistochemical and ultrastructural studies on the tumor cells are reported, and their distinctive characteristics are discussed in details.
Cell Proliferation ; Child ; Female ; Granuloma, Plasma Cell ; Humans ; Mediastinum* ; Myofibroblasts* ; Young Adult

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Ligaments ; Male ; Pathology ; Silicones ; Synovitis ; Wrist

Purpose: To report the outcomes of extensively porous-coated femoral stems based on diaphyseal fixation caused by extensive bone loss and osteoporosis of the proximal femur in revision total hip arthroplasty. Materials and Methods: 14 cementless femoral revision procedures performed between Aug, 2000 and Apr, 2003 were reviewed retrospectively. The follow up period ranged from 24 to 53 months, with an average of 33 months. The average age at surgery was 52.3 years, there were 10 males and 4 females. The reasons for the revision surgery were aseptic loosening in 11(78.7%) hips, progressive osteolysis in 1(7.1%), septic loosening in 1(7.1%) and periprosthetic fracture in 1(7.1%). Results: The Harris hip score improved from 50.4 points preoperatively to 88.5 points postoperatively. The complications encountered were a greater trochanteric fracture in 2 hips (14.3%), periprosthetic fracture in 1(7.1%), dislocation of the hip in 2(14.3%), and minimal thigh pain in 2(14.3%). Radiographic evidence of a bone ingrown stem was found in 11 hips (78.6%), and 3 hips (21.4%) showed stable fibrous fixation. Stem subsidence > 5mm was noticed in 1 hip (7.1%) and > 10mm in 2 (14.3%) but there was no further progression after 1 year. Moderate stress-shielding was noticed in 4 hips(28.6%). To date, no significant wear or osteolysis has been observed. Conclusion: An extensively porous-coated revision stem appears to be a reasonable choice in the presence of proximal femoral bone loss as a short term follow up. However, the concerns related to the postoperative complications will require a longer term follow up.
Arthroplasty, Replacement, Hip* ; Dislocations ; Female ; Femur ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Osteoporosis ; Periprosthetic Fractures ; Postoperative Complications ; Retrospective Studies ; Thigh

Splenic metastasis from solid cancer is a rare clinical event. Especially splenic metastasis from the lung is very rare. Most spleen metastases are found at autopsy and are part of a widely spread disease. Solitary splenic metastasis in the abscence of other metastases is extremely rare. The authors report the case of a 54-year-old man in whom the only discover distant metastasis from lung cancer was a splenic mass. The splenic lesion was detected after the resection of the primary lung lesion. The time from diagnosis to the development of splenic metastasis was 25 months. The rarity of a solitary spleen metastasis from lung cancer and the treatment modalities are discussed. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated, a splenectomy followed by combined modality treatment to prevent the spread and aggravation of the disease.
Autopsy ; Diagnosis ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Neoplasm Metastasis* ; Spleen ; Splenectomy

No abstract available.
Radiosurgery* ; Trigeminal Neuralgia*

No abstract available.
Neck*

Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum* ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy*

OBJECTIVE: Although hydroxyapatite (HA) spacer has been used for laminoplasty, there have been no reports on factors associated with fusion and on the effects of HA shape. METHODS: During January 2004 and January 2010, 45 patients with compressive cervical myelopathy underwent midline-splitting open door laminoplasty with winged (33 cases) and wingless (12 cases) HAs by a single surgeon. Minimal and mean follow up times were 12 and 28.1 months, respectively. Japanese Orthopedic Association (JOA) score was used for clinical outcome measurement. Cervical X-rays were taken preoperatively, immediately post-operatively, and after 3, 6, and 12 months and computed tomography scans were performed preoperatively, immediately post-operatively and after 12 months. Cervical lordosis, canal dimension, fusion between lamina and HA, and affecting factors of fusion were analyzed. RESULTS: All surgeries were performed on 142 levels, 99 in the winged and 43 in the wingless HA groups. JOA scores of the winged group changed from 10.4+/-2.94 to 13.3+/-2.35 and scores of the wingless group changed from 10.8+/-2.87 to 13.8+/-3.05. There was no significant difference on lordotic and canal dimensional change between two groups. Post-operative 12 month fusion rate between lamina and HA was significantly lower in the winged group (18.2 vs. 48.8% p=0.001). Multivariate analysis showed that ossification of the posterior longitudinal ligament, male gender, and wingless type HA were significantly associated with fusion. CONCLUSION: Clinical outcome was similar in patients receiving winged and wingless HA, but the wingless type was associated with a higher rate of fusion between HA and lamina at 12 months post-operatively.
Animals ; Asian Continental Ancestry Group ; Durapatite ; Follow-Up Studies ; Humans ; Longitudinal Ligaments ; Lordosis ; Male ; Multivariate Analysis ; Orthopedics ; Spinal Cord Diseases