Purpose: Dislocation is the second most common cause of failure, after implant loosening, in revisional THA (Total hip arthroplasty), and its evaluation and treatment still remain controversial issue. This study was undertaken to evaluate the risk factors after THA using the posterolateral approach and posterior soft tissue repair. Materials and Methods: Between January 1998 and May 2003, 211 consecutive primary total hip replacement arthroplasties using the posterolateral approach and posterior soft tissue repair were performed by the same surgeon. To compare the dislocation groups (6 cases) with the non-dislocation groups (205 cases), we randomized 120 of the non-dislocation cases. The risk factors for hip dislocation were categorized into patient factors and surgical factors. Patient factors included gender, age, preoperative diagnosis, underlying systemic disease, and alcoholic history. Surgical factors included position of the component (acetabular version and inclination, femoral anteversion), leg length discrepancy, and sum of anteversions of the cup and stem. Their parameters were measured on postoperative radiographs. Statistics were performed with Fishe`s Exact test and T test. Results: Dislocations occurred at an overall incidence rate of 2.8% (6/211cases). There were 4 (1.9%) cases of anterior dislocations and 2 (0.9%) cases of posterior dislocations. Dislocations occurred on average at postoperative day 6.1 and all dislocated hips were reduced with the closed method, except for one case that was treated surgically. There was no statistical significance in patient factors between the two groups, except for neurologic disease and alcoholic history. However, the sum of the acetabular and femoral anteversions in the anterior dislocation group was larger than that of the non-dislocation group by approximately 19 degrees. Conclusion: Our results demonstrated that by using the posterior approach and repair of soft tissue, the posterior dislocation rate after total hip replacement arthroplasty can be reduced and the sum of the acetabular and femoral anteversions had more influence on dislocations after THAs than did either anteversion alone.
Acetabulum ; Alcoholics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Diagnosis ; Dislocations ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Leg ; Risk Factors*

The authors performed this preliminary study to investigate the effect of softening E.C.T. and propofol was compared to pentothal for induction of anaesthesia for E.C.T on seizure duration. The results were follows ' 1) E.C.T. was performed in 60 psychiatric inpatients who were admitted during the study period. Of them 51.7% were diagnosed as schizophrenia, 21.6% as major depressive disorder, 16.7% as bipolar I disorder, manic and 10% of others. 2) Mean number of E.C.T. was 12.2 times a patient. 3) The most common target symptoms were persecutory delusion in schizophrenia, psychomotor retardation or agitation in major depressive disorder, and violent aggressive behavior in bipolar I disorder, manic. 4) Pre-ECT medication usually used were atropine 0.0093mg kg(-1), pentothal 2.76mg kg(-1) or propofol 1.42mg kg(-1). 5) The duration of seizure, as measured clinically, was reduced with propofol(20.5 sec) in comparison with pentothal(35.7 sec)(p<0.001). This suggest the possibility that additional treatment may be needed for the same clinical effect in psychiatric illness when propofol is used as the induction agent.
Atropine ; Bipolar Disorder ; Delusions ; Depressive Disorder, Major ; Dihydroergotamine ; Electroconvulsive Therapy ; Humans ; Inpatients ; Propofol* ; Schizophrenia ; Seizures* ; Thiopental*

PURPOSE: Observation of operations is believed to be a major part in the clinical clerkship of surgery, but it is very hard to be performed effectively due to the difficulty of providing an appropriate view of surgical field for many students. To overcome this problem, we have started to provide a tele-video system for clinical clerkship of surgery since 2001. The aim of this study was to evaluate the effectiveness of educational program of surgery using tele-video system. METHODS: We provided the tele-video system with camera systems in two operating rooms and 2 video projection systems in the teaching room to the third year medical students as a curriculum of clinical clerkship of surgery. Education using tele-video system was performed in the form of the interrogatory teaching between the teacher (operator) and students using microphone. The questionnaires about the program of clinical clerkship of surgery and the education with tele-video system were filled up by 190 students who had completed the 4 weeks clerkship schedule. After then, items in the questionnaires were analyzed in September and in December to evaluate the change of the students' response for the education with tele-video system. RESULTS: Eighty-eight percent of students had experienced the education with tele-video system. Most students (96%) recommended this system to their juniors, and 78% of students wanted this system to be also used in other departments' clinical clerkship. The advantages of tele-video system were revealed as the better view of surgical field, followed by clear explanation for the surgical procedure, interrogatory teaching between the operator and the students, and so on. The most effective teaching methods were revealed as direct participating in the operation (33%), followed by tele-video system (32%), reading of textbook (19%), and simple observation of the operation (15%). General satisfaction for tele-video system were scored with five (11%), four (48%), three (25%), two (7%), and one (1%) (5=excellent, 1=very poor). General satisfaction rate about tele-video system was markedly improved from September to December. CONCLUSIONS: The education with tele-video system in the clinical clerkship of surgery seems to be very effective method for teaching the medical students.
Appointments and Schedules ; Clinical Clerkship ; Curriculum ; Education ; Humans ; Operating Rooms ; Students, Medical* ; Teaching ; Surveys and Questionnaires

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*

The prevalence of metastatic tumorous lesion at medial clavicle or sternoclavicular joint is low. Herein, we presented a 45-year-old female patient with left sternoclavicular joint pain followed a weight-lifting exercise. The patient was initially diagnosed as traumatic sternoclavicular arthrosis, however, on later computed tomography scan demonstrated the bony destruction of medial clavicle which was diagnosed as metastasized non-small cell lung carcinoma after a fine needle biopsy.
Adenocarcinoma ; Biopsy, Fine-Needle ; Clavicle ; Female ; Humans ; Lung Neoplasms ; Lung* ; Middle Aged ; Neoplasm Metastasis ; Prevalence ; Sternoclavicular Joint*

Odontogenic keratocysts are benign intraosseous tumors of odontogenic origin that occur most commonly in the jaw. In particular, they have a predilection for the angle and ascending ramus of the mandible. In contrast, odontogenic keratocysts arising in the maxillary sinus are relatively rare. Two such cases are reported herein. In addition, the English literature that concerns odontogenic keratocysts of the maxillary sinus is reviewed.
Jaw ; Mandible ; Maxillary Sinus ; Odontogenic Cysts ; Tooth

BACKGROUND/AIMS: Treatment of chronic hepatitis B with interferon results in a sustained loss of hepatitis B virus DNA and hepatitis B e antigen (HBeAg) and remission of liver disease only in a proportion of cases. Recently, mutations of hepatitis B virus (HBV) core gene have been reported as being related to the failure of interferon treatment in chronic hepatitis B. This study investigated whether core gene mutations of HBV are related to non-response to interferon therapy and whether the recurrence of HBeAg and HBV DNA in initial responders to interferon therapy is associated with the emergence of HBV core gene mutants. METHODS: The precore/core gene sequence was determined by polymerase chain reaction (PCR) and direct sequencing of PCR product in serum samples obtained before interferon treatment from 10 responders and 10 non-responders to interferon therapy. In addition, precore/core gene sequence was determined in serum samples obtained before interferon treatment and after recurrence from 10 patients who showed recurrence of HBeAg and HBV DNA after initial response to interferon therapy. RESULTS: In samples from 10 responders, there were 7 missense mutations and 71 silent mutations. However, there were 43 missense mutations and 109 silent mutations in samples from 10 non-responders. In samples obtained before interferon treatment from the 10 patients who showed recurrence after initial response, 8 missense mutations and 74 silents mutations were found. The nucleotide sequences from the samples obtained after the recurrence showed 6 silent nucleotide substitutions compared with the sequences from the samples obtained before interferon treatment. CONCLUSIONS: Mutations in the core protein of HBV occur more frequently in non-responders than responders to interferon therapy of chronic hepatitis B and may be a factor responsible for the failure of interferon treatment. The recurrence of HBeAg and HBV-DNA in initial responders to interferon therapy is not associated with the emergence of the HBV core gene mutants.
Adolescent ; Adult ; Antiviral Agents/*therapeutic use ; DNA, Viral/genetics ; English Abstract ; Female ; Hepatitis B Virus/*genetics ; Hepatitis B, Chronic/*drug therapy/virology ; Human ; Interferon-alpha/*therapeutic use ; Male ; *Mutation ; Viral Core Proteins/*genetics

Sleep-disordered breathing in children can include habitual snoring, obstructive hypoventilation, upper airway resistance syndrome, and obstructive sleep apnea. Obstructive hypoventilation in children is characterized by CO₂ retention caused by prolonged partial upper airway obstruction during sleep. To date, there have been few studies regarding the clinical significance and management strategies in pediatric obstructive hypoventilation, although it is a unique feature of pediatric sleep-disordered breathing. In this report, we describe two cases of obstructive hypoventilation that demonstrated improvement following upper airway surgery. These results suggest that upper airway surgery could be an additional treatment modality in obstructive hypoventilation.
Airway Obstruction ; Airway Resistance ; Child ; Humans ; Hypoventilation* ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring

PURPOSE: The purpose of this study was to analyze the clinical and radiological results of distal chevron osteotomy in patients aged 50 and older with moderate-to-severe hallux valgus. MATERIALS AND METHODS: The authors reviewed the medical records and radiographs of 19 patients (26 feet). Average age at time of surgery was 58 years and the mean follow-up period was 3 years and 1 month. For radiological evaluation, we analyzed changes in hallux valgus angles and 1st-2nd intermetatarsal angles after index operations. Clinical results were assessed with respect to pain, activities of daily living, and shoe-wear. RESULTS: Hallux valgus angles and 1st-2nd intermetatarsal angles improved, but considerable correction loss occurred with time. This correction loss was found to be significantly correlated with preoperative subluxation of the 1st metatarsophalangeal joint and the 1st-2nd intermetatarsal angle. Clinically, remarkable improvements were achieved in terms of pain and level of activity, but most patients (except 4) still wore comfortable shoes rather than hard shoes at latest follow-ups. CONCLUSION: Distal chevron osteotomy is beneficial for patients aged 50 and older with moderate-to- severe hallux valgus deformity, but correction loss may occur in patients with marked subluxation of the 1st metatarsophalangeal joint or a severe 1st-2nd intermetatarsal angle.
Activities of Daily Living ; Aged ; Congenital Abnormalities ; Follow-Up Studies ; Hallux ; Hallux Valgus ; Humans ; Medical Records ; Metatarsophalangeal Joint ; Osteotomy ; Shoes

Background: On February 21, 2020, 2 coronavirus disease 2019 (COVID-19) cases in pilgrim travelers from Korea to Israel were identified. We investigated the source of infection, clinical features of COVID-19, and transmission potential of presymptomatic and asymptomatic cases. Methods: All 39 pilgrim travelers were aggressively tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Their clinical features and possible source of infection were investigated by interview and review of their medical records. Ten confirmed cases without symptoms at the first sampling dates were selected for follow-up reverse transcription polymerase chain reaction tests. Results: Of the 39 pilgrim travelers, 30 (77%) were positive for SARS-CoV-2. Among the 30 positive COVID-19 cases, 4 (13%) were asymptomatic. Available follow-up cycle threshold values from 10 cases gradually increased over time and were lower during the presymptomatic period than during the postsymptomatic period. Out of 328 contacts related to the COVID-19 cases in the pilgrim travelers, 22 additional cases (7%) were confirmed with SARS-CoV-2 infections. Three tertiary cases were identified to be transmitted by presymptomatic secondary cases. Conclusion To prevent transmission of COVID-19, we need to focus on presymptomatic and asymptomatic cases, and massive testing for SARS-CoV-2 is required. More research about the possibility of presymptomatic transmission over 2 days before symptom onset is required.