Osteoporosis has been described as the most common disease in the old age group. As the bone mineral density decreases, the skeleton becomes more prone to fracture. Hip fractures occur late in life following substantial reduction in skeletal mass. So the incidence of hip fracture is increasing due to prolongation of average life span. The bone density of femoral neck, Ward triangle, and trochanteric region were measured by dual energy x-ray absorptiometry (DEXA) in 15 patients with femoral neck fractures and in 58 patients with intertrochanteric fractures to evaluate the relationship between bone mineral density (BMD) value and fracture type. The results were as follows 1. In femoral neck fracture group, the mean BMD value was 0.59+/-0.02 g/cm2 in femoral neck, 0.38+/-0.08 g/cm2 in Ward triangle and 0.48+/-0.09 g/cm2 in trochanteric region. In intertrochanteric fracture group, the mean BMD value was 0.57+/-0.09 g/cm2 in femoral neck, 0.39+/-0.10 g/cm2 in Ward triangle, and 0.47+/-0.13 g/cm2 in trochanteric region. 2. In femoral neck fracture group, the fracture threshold value was 0.75 g/cm 2 in femoral neck, 0.60 g/cm2 in Ward triangle and 0.67 g/cm2 in trochanteric region. In intertrochanteric fracture group, the fracture threshold value was 0.63 g/cm2 in femoral neck, 0.51 g/cm2 in Ward triangle, and 0.57 g/cm2 in trochanteric region. In conclusion, there was no statistical relationship in BMD value between neck fracture and intertrochanter fracture group, and no statistical relationship between BMD value and each fracture type in femoral neck and intertrochanter fracture. The type of hip fracture may be related to the degree of trauma rather than the value of the BMD.
Absorptiometry, Photon ; Bone Density* ; Femoral Neck Fractures ; Femur ; Femur Neck ; Hip Fractures ; Hip* ; Humans ; Incidence ; Neck ; Osteoporosis ; Skeleton

No abstract available.
Laurence-Moon Syndrome*

No abstract available.
Laurence-Moon Syndrome*

Except for the hallux, the human toes classically present three phalanges, distal, middle and proximal. However in 5th toe, only two phalanges are frequently observed. In this condition, known as synarthrosis of the distal interphalangeal joint, the middle and distal phalanges are fused together to appear as symphalangism or biphalangeal 5th toe. Phalanges of 5th toe was investigated in 1,187 cases of Korean radiographs. The incidence of symphalangism was found to be 74% in 1,150 adult. The bilaterality was 99%. To prove proove the genetic basis of the symphalangism, pedigree studies were performed. The symphalangism of the 5th toe was supposed to be an autosomal dominant trait. As an phenotype of recessive homozygote the triphalaneal subjects were traced to investigate their families. Pedigrees of four families in which both parents had triphalangea of 5th toe showed that their offsprings always showed the triphalangea. Therefore, it suggests the symphalangism inherit as a Mendelian dominant trait and it seems to be an example of microevolution or genetic adaptation to bipedalism.
Adult ; Genetics ; Hallux ; Homozygote ; Humans ; Incidence ; Joints ; Parents ; Pedigree ; Phenotype ; Toes*

No Abstract Available.
Health Behavior*

Infection in primary total hip arthroplasty may cause catastrophic results and is the major reason for implant failure. The purpose of this study was to evaluate the utility of the hip joint fluid culture as a method of predicting the possibility of a hip joint infection by calculating the sensitivity, specificity and accuracy. We performed 628 primary total hip arthroplasty and aerobic and anaerobic bacterial cultures for hip joint fluid between January 1989 and June 1996. The hip joint fluid culture was routinely performed to evaluate the utility of the femoral head for bone banking. Thirty-two cases out of the 628 hips showed positive intraoperative culture and 596 cases showed negative intraoperative culture. The isolated organisms from 32 positive cultures were 11 for Staphylococcus aureus, eight for Staphylococcus coagulase negative, seven for Enterococcus, three for E.coli and one each for Enterobacter, Acinetobacter and Pseudomonas. Anaerobic culture was negative in all cases. In the positive intraoperative culture cases, none had delayed infection during the follow-up period. But in the negative intraoperative culture cases, one case had acute infection and two cases had delayed infection. In the case with acute infection, Staphylococcus aureus was isolated and on two cases with delayed infection, Enterococcus and Staphylococcus coagulase negative were isolated, respectively. All 32 positive culture cases were fa~lse positive and 595 negative culture cases were true negative and one negative culture case was fa~lse negative. The sensitivity of the hip joint culture was 0%, the specificity was 94.9% and the accuracy was 0%. The specificity of hip joint fluid culture in primary total hip arthroplasty was high, hut the sensitivity score was zero. Therefore, the hip joint fluid culture should not be used for a routine check of infection status in primary total hip arthroplasty. We recommend the hip joint fluid culture in revision arthroplasty or hips in which infection is clinically suspected.
Acinetobacter ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bone Banks ; Coagulase ; Enterobacter ; Enterococcus ; Follow-Up Studies ; Head ; Hip Joint* ; Hip* ; Pseudomonas ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

PURPOSE: To evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes. METHODS: We retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results. RESULTS: The mean preoperative BCVA (log MAR) was 0.91+/-0.40 (0.8-1.2). The BCVA improved to 0.72+/-0.39 (0.3-1.2). The mean preoperative macular thickness was 440+/-130 (202-805) micrometer and the mean macular thickness decreased to 306+/-97 (136-580) micrometer postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA. CONCLUSIONS: In eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.
Adult ; Aged ; Diabetic Retinopathy/*surgery/therapy ; Female ; Humans ; Injections ; Laser Coagulation ; Macular Edema/*surgery/therapy ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Treatment Outcome ; Triamcinolone/administration & dosage/therapeutic use ; *Vitrectomy ; Vitreous Body

PURPOSE: To compare 23-gauge transconjunctival sutureless vitrectomy (TSV) and sutured vitrectomy in the aspect of intraocular pressure (IOP) changes and complications. METHODS: Through a retrospective chart review, 45 sutureless patients (48 eyes) and 48 sutured patients (52 eyes) who had undergone 23-gauge transconjunctival vitrectomy by one surgeon (J.H. Sohn) were compared. IOP was measured routinely pre-operativley, at 1 day, 1 week, and 1 month post-operatively. Postoperative IOP, hypotony (IOP<7 mmHg) rates and complications associated with hypotony were assessed respectively. In addition, the cases involving intraocular air or gas tamponade or cataract extraction were compared. RESULTS: One day after the surgery, 3 eyes of the sutureless group developed hypotony,which persisted in 2 eyes through postoperative 1 week. Two eyes of the sutureless group developed hypotony 1 week after the surgery. Most of the hypotony cases were transient, but choroidal detachment occurred in 2 cases, and retinal detachment occurred in 1 case. In contrast, none of the sutured group developed hypotony. Intraocular air or gas tamponade significantly raised IOP 1 day after the surgery. When the operation was combined with cataract extraction, IOP was reduced postoperative 1 week and 1 month. CONCLUSIONS: The well-known risk factor of 23-gauge sutureless vitrectomy is postoperative hypotony. The present study showed postoperative hypotony can result in retinal detachment as a complication in contrast to previous studies. The authors conclude that suturing the wound for the prevention of hypotony is better, especially in cases with high risk of hypotony or definite wound leakage.
Cataract Extraction ; Choroid ; Eye ; Humans ; Intraocular Pressure ; Retinal Detachment ; Retrospective Studies ; Risk Factors ; Vitrectomy

OBJECTIVES: This study was performed to evaluate the sleep patterns in a population of Korean labor workers and to assess the activity of the autonomic nervous system in relation to sleep habits. METHODS: A sampler of 1238 daytime workers (male 911, female 327) completed questionnaires on sleep habits and their short term heart rate variability(HRV) was also examined. We used the SA-2000 (medi-core) instrument for 5 minutes for each participant in the morning and performed basic physical examinations including height, weight, and blood pressure. RESULTS: Bed time and wake up time were negatively correlated with age, while the frequencies of waking up through the night and in the early morning showed positive correlation with age. We found that bed time and wake up time during weekdays, sleep latency during weekdays, frequency of waking up through the night, and the degree of sleepiness all varied significantly according to the average nightly amount of sleep within the last week. There was a positive correlation between wake up time at weekdays with mean heart rate. However, the other variables of sleep habits and pattern did not show significant correlation with HRV. CONCLUSION: Among Korean daytime workers, sleep phases become advanced with aging. In spite of the aging processes, general sleep health seems to be maintained among the healthy worker group. However, short-term HRV was not useful parameter to measure the alternation of autonomic nervous system resulting from the difference of sleep habits and pattern.
Aging ; Autonomic Nervous System ; Blood Pressure ; Female ; Heart Rate* ; Heart* ; Humans ; Korea* ; Physical Examination ; Questionnaires

OBJECTIVES: The aim of this study is to evaluate the practical role of 3D-CTA in planning the surgery for intracranial aneurysm from a viewpoint of operator. METHODS: Since May 1997 to April 1998, a total of 65 patients who were suspected to have intracranial aneurysms were studied with 3D-CTA using a General Electric Hispeed Advantage helical scanner. Conventional intraarterial digital subtraction angiographies(IA-DSAs) were performed in all patients except four who were in urgent situation. With the images obtained from the 3D-CTA, we performed preoperative assessments for the targeted aneurysms and evaluated its usefulness for planning the aneurysm surgery. RESULTS: 3D-CTA revealed 69 intracranial aneurysms in 55 patients and the size of aneurysms detected were 2-17mm in diameter. The sensitivity of 3D-CTA(95.8%) which was based on the comparison with IA-DSA and supplemented by microsurgical finding was similar to that of IA-DSA(94.1%) and its specificity(81.8%) was lower than that of IA-DSA(100%). Time consuming for getting images from 3D-CTA was no more than 20 minutes and this rapidity was very useful in the emergent situation such as cases of large intracerebral hematoma or massive intraventricular hemorrhage. 3D-CTA proffered various perspective views including surgical view, which were valuable to estimate the degree of head rotation and the direction of clip insertion and to determine the permanent clip type preoperatively. Careful reviewing of 3D-CTA made it possible to minimize surgical procedures. We could omit routine rectus gyrus resection in twelve of 16 surgeries for A-com aneurysm and could operate sixteen of 19 ICA aneurysms successfully without routine extracranial carotid artery preparation. On the basis of 3D-CTA, we could select the appropriate surgical approach in cases of ophthalmic aneurysm or posterior circulation aneurysm. Moreover, in cases of bilateral multiple aneurysms, 3D-CTA was helpful for evaluating the possibility of visualizing contralateral aneurysm through unilateral approach. The extent of bone work could be determined preoperatively through reviewing the 3D-CTA images and possible rupture of MCA aneurysm during bone work could be avoidable. However, 3D-CTA had some limitations for the describing fine vascular architecture such as the teat of aneurysm, a clue for the ruptured aneurysm in multiple aneurysms and most of fine caliber vessels such as hypoplastic posterior communicating artery or anterior choroidal artery was missed on the 3D-CTA. 3D-CTA lacked description for the hemodynamics of cerebral circulation. CONCLUSIONS: Although the 3D-CTA is still insufficient to be the complete substitute for conventional intraarterial digital subtraction angiography, it may be excellent adjunctive tool in planning the surgery of intracranial aneurysm considering that understanding the exact relationship of aneurysm with surrounding structure is mandatory for minimizing the possible risk during surgery.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Angiography, Digital Subtraction ; Arteries ; Carotid Arteries ; Choroid ; Head ; Hematoma ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Rupture