Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

Isolated fracture of the distal humeral trochlea occurs while the axial load delivered to the elbow passes through the trochlear of the distal humerus. It has been rarely reported, because of those reasons. The trochlea is located deep inside of the elbow joint space and since it does not have the direct attachment with muscles or ligaments, a force is hardly transmitted directly. Also ulno-humeral joint is less influenced by compressive or shear force than radio-humeral joint. We report a case of isolated trochlear fracture with review of the literature.
Elbow ; Elbow Joint ; Humerus ; Joints ; Ligaments ; Muscles

High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.
Anti-Bacterial Agents ; Debridement ; Fracture Fixation ; Fractures, Open ; Humans ; Humerus ; Military Personnel ; Wounds and Injuries ; Wounds, Gunshot

PURPOSE: We wanted to assess the clinical results and the complications of treating femoral head fractures. MATERIALS AND METHODS: Twenty patients with femoral head fractures and who had a minimum 1 year follow up were enrolled in this study from April 2004 to June 2008. The clinical outcomes were evaluated according to the mechanism of injury, the reduction time, the Pipkin classification, the treatment methods, the surgical approach and the complications. RESULTS: There were 5 cases of Pipkin type I and 2 cases of Pipkin type II, 1 case of Pipkin type III and 12 cases of Pipkin type IV. All the patients underwent operation except 1 patient; there were 5 excisions, 7 internal fixations, 1 prosthesis, and 6 internal fixations of combined acetabular fixation without surgery for the femoral head fractures. The average Harris hip score at 1 year after operation was 80.0 (range: 57~99): there were 4 excellent, 7 good, 5 fair and 4 poor results. The complications of the femoral head fractures were 2 cases of avascular necrosis and 2 cases of posttraumatic osteoarthritis. CONCLUSION: Internal fixation of the femoral head with using Herbert screws showed a favorable outcome, while excision of the femoral head fragments did not. Internal fixation of Pipkin type 1 or 2 fractures could be performed by the anterior approach. The posterior approach combined with surgical dislocation is especially useful in internal fixation of concurrent posterior acetabular fractures, and it has the advantage of preserving the blood supply to the femoral head.
Dislocations ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Dislocation ; Humans ; Imidazoles ; Necrosis ; Nitro Compounds ; Prostheses and Implants

PURPOSE: This study examined the clinical course of subtrochanteric fractures of the femur as well as the risk factors of complications. MATERIALS AND METHODS: A retrospective study was performed on 56 patients with femoral subtrochanteric fractures who were treated at our hospital from 2004 to 2008. Risk factors, such as the type of fracture, type of implant, soft tissue dissection at the fracture site, communition of the medial cortex and degree of fracture displacement after the reduction, were compared to determine their effect on the rate of complications, such as nonunion and implant failure. Open reduction with a soft tissue dissection at the fracture site was performed in 34 cases, and a closed reduction was performed in 22 cases. Thirty five cases had medial cortex communition and 21 cases did not. RESULTS: There were 8 cases of nonunion(14.3%). There was a positive correlation between the degree of fracture displacement after the reduction and the union time (P=0.017). The union time was longer when there was communition of the medial cortex. A subtrochanteric fracture using an open reduction tended to have a long union time but this was not statistically significant. There was no correlation between the type of implant and union time. CONCLUSION: The union time is longer in subtrochanteric fractures with communition of the medial cortex. Therefore, it is important to preserve the blood supply at the fracture site using a closed reduction and restore the fracture reduction accurately.
Displacement (Psychology) ; Femur ; Hip Fractures ; Humans ; Retrospective Studies ; Risk Factors

OBJECTIVE: To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.METHODS: Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.RESULTS: The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4–5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).CONCLUSION: Patients with high BMI or severe disc degeneration should be informed of HLD revision.
Body Mass Index ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors

Purpose: This study compared the clinical and radiological results of the femoral neck system (FNS) and cannulated compression screws (CCS) for the fixation of femoral neck fractures. Materials and Methods: Patients who underwent FNS or CCS internal fixation for femoral neckfractures between January 2016 and January 2022 were analyzed retrospectively. The hip joint function using the Harris hip score (HHS) was evaluated three months and one year after surgery. The operation time, fracture healing time, and associated surgical complications in the two groups were compared and analyzed statistically. Results: Seventy-nine patients were categorized into 38 FNS and 41 CCS groups. The FNS group had a longer operation time and higher postoperative HHS at three months (p<0.01). Femoral neck shortening was lower in the FNS group (p=0.022). There were no significant differences in the fracture healing time and other complications. Conclusion There were no differences in most clinical outcomes and complications between the two groups except for the three-month HHS and femoral neck shortening. This study suggests that FNS could be an alternative to CCS for treating femoral neck fractures.

BACKGROUND: Non-Q weve myocardial infarction(NQMI) is known to have smaller infarct size and less degree of ventricular dysfunction than Q wave myocardial infarction(QMI). However, clinical characteristics of NQMI compared to QMI are not known exactly. To evaluate the clinical outcome of NQMI, retrospective analysis of NQMI was performed. METHOD: Subjects were 155(123 male, 32 female; 61.1+/-11.4 years) patients with acute myocardial infarction who visited the emergency room of Chonnam University Hospital between January 1995 and July 1996. Inclusion criteria were prolonged(>30 min) angina, persistent EKG changes consistent with QMI or NQMI, an increase(twice than normal) in serum CK(nomal; 30-170 U/L) with CK-MB(normal; 0-16 U/L) enzyme. Thirty four(28 male, 6 female; 62.7+/-11.2 years) patients were diagnosed as NQMI and 121(95 male, 26 female; 60.6+/-11.5 yrs) patients as QMI. RESULTS: 1) Percentage of patients who recevedthrombolytic therapy was not different between NQMI(50%) and QMI(51%). 2) There was no differences in the atherosclerosis risk factors between NQMI and QMI. 3) Peak cardiac enzyme was not different between NQMI and QMI. 4) Lateral wall infarction by EKG was more frequent in NQMI than QMI(8.8 vs. 0.8%, p<0.05). 5) According to coronary angiogram, LCX involvement was more frequent in NQMI than in QMI(17.8 vs. 1%, p<0.05). 6) Percentage of coronary revascularizations, including PTCA and CABG, was not different between two groups. 7) There were no differences in the incidences of in-hospital mortality and arrhythmia between two groups. 8) During 10.9+/-11 months'follow-up, reinfarction rate was more frequent in NQMI than in QMI(7.1 vs. 2%,p<0.05). CONCLUSION: NQMI is associated with similar complication rates with QMI and higher reinfarction rates than QMI, and thus NQMI should be treated rigorously at early and follow-up time periods.
Arrhythmias, Cardiac ; Atherosclerosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Incidence ; Infarction ; Jeollanam-do ; Male ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors ; Ventricular Dysfunction

PURPOSE: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. MATERIALS AND METHODS: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. RESULTS: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). CONCLUSIONS: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Knee Prosthesis ; Knee ; Prostheses and Implants ; Survival Rate

Background: Implant-based immediate breast reconstruction surgery with nipple-sparing mastectomy has recently been favored by patients. However, in patients who do not wish to undergo balancing procedures, it is difficult to select the appropriate implant size, making it challenging to achieve a symmetrical breast shape. Therefore, this study investigated the differences in breast asymmetry and other complications in patients who underwent a two-stage procedure or direct-to-implant (DTI) breast reconstruction to determine whether the two-stage procedure can produce more favorable outcomes. Methods: The participants of this study were patients who underwent immediate two-stage breast reconstruction or DTI breast reconstruction from May 2018 to April 2022, did not receive postoperative radiotherapy, and did not wish to undergo any balancing procedures. An acellular dermal matrix was used for breast reconstruction in all patients, and a single reconstructive surgeon performed all the operations. Statistical significance was set at P<0.05. Results: No significant differences in complications were found between the patients who underwent DTI breast reconstruction and those who underwent two-stage breast reconstruction. In the two-stage breast reconstruction group, breast volume asymmetry was observed in 18.4% (seven patients), which was significantly lower than the percentage of 44.7% (17 patients) observed in the DTI group. Conclusions Breast asymmetry was observed in a significant proportion of the patients in both groups. However, because breast volume asymmetry was more common in the DTI group than in the two-stage breast reconstruction group, two-stage breast reconstruction may be a favorable method for patients who do not wish to undergo balancing procedures.