Injuries to the extensor mechanism include a wide range of injuries from minor one to massive defect. And the methods of treatment must be individualized according to the anatomical site, extent and chronicity of injuries. The extensor mechanism is a triangular thin sheet like structure, the function of which cannot be explained completely by the Tubiana's church-steeple like diagram. Authors think that the extensor mechanism should be repaired or reconstructed as a triangular sheet. The tension of the repaired or reconstructed tendon was estimated as good when the neutral extensions were obtained in all the MP, PIP and DIP joints after the completion of sutures. Also authors think that stable sutures are mandatory for the early rehabilitation postopoeratively. Seventy-five patients have been treated by the authors from 1982 to 1994. According to zonal classification, forty-two patients were injured in Zone I. 5 in Zone II, 21 in Zone III, 5 in Zone IV and 2 patients were unclassified due to massive defects of the extensor mechanism. Mostly bony mallet injuries were treated by open reduction and K-wire fixation. Acute tendinous mallet injuries were treated by conservative splinting and old injuries were treated by anatomical plication of the terminal extensor tendon. Old buttonhole deformities were generally treated by the central tendon plication. Massive defects were managed by skin coverage and reconstruction of the extensor mechanism by using a tendon graft which was tailored like a triangular thin sheet. With author's treatment principles, excellent or good results were obtained in about 87%. Consequently, authors emphasize that an anatomical repair or reconstruction is a keystone in the treatment of injuries to the extensor mechanism.
Classification ; Congenital Abnormalities ; Fingers ; Fluconazole ; Humans ; Joints ; Rehabilitation ; Skin ; Splints ; Sutures ; Tendons ; Transplants

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

BACKGROUND AND OBJECTIVES: No existing device for cardiopulmonary resuscitation(CPR)isdesignedto exploit both the "cardiac pump" and the "thoracic pump" simultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR (SST-CPR) vs. standard CPR (S-CPR) using a mechanical resuscitator in a canine model of cardiac arrest. DEVICE DESCRIPTION: We have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. MATERIALS AND METHODS: Twelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO2 were measured while each method of CPR was performing. RESULTS: SST-CPR resulted in significantly higher mean arterial pressure than S-CPR (68.9+/-16.1 vs 30.5+/-10.0 mmHg, p<0.01). SST-CPR could generate higher coronary perfusion pressure than S-CPR (47.0+/-11.4 vs 17.3+/-8.9 mmHg, p<0.01). End tidal CO2 tension was also higher during SST-CPR than S-CPR (11.6+/-6.1 vs 2.17+/-3.3 mmHg, p<0.01). CONCLUSION: Simultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation.
Animals ; Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters ; Dogs ; Heart Arrest* ; Heart Atria ; Heart Ventricles ; Hemodynamics* ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: No existing device for cardiopulmonary resuscitation(CPR)isdesignedto exploit both the "cardiac pump" and the "thoracic pump" simultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR (SST-CPR) vs. standard CPR (S-CPR) using a mechanical resuscitator in a canine model of cardiac arrest. DEVICE DESCRIPTION: We have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. MATERIALS AND METHODS: Twelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO2 were measured while each method of CPR was performing. RESULTS: SST-CPR resulted in significantly higher mean arterial pressure than S-CPR (68.9+/-16.1 vs 30.5+/-10.0 mmHg, p<0.01). SST-CPR could generate higher coronary perfusion pressure than S-CPR (47.0+/-11.4 vs 17.3+/-8.9 mmHg, p<0.01). End tidal CO2 tension was also higher during SST-CPR than S-CPR (11.6+/-6.1 vs 2.17+/-3.3 mmHg, p<0.01). CONCLUSION: Simultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation.
Animals ; Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters ; Dogs ; Heart Arrest* ; Heart Atria ; Heart Ventricles ; Hemodynamics* ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation

BACKGROUND: The purpose of this study was to compare clinical aspects of pelvic fractures in an aged group with a non-aged group and to delineate its characteristics to improve prevention and treatment. METHODS: Medical records and radiological examinations of 100 cases were reviewed. Two groups were created, older than 65 years and younger than 65 years. In addition, the following were carefully examined and recorded-gender distribution, cause and types of fractures, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale, need for intensive care unit admission, duration of hospitalization, and mortality rate. RESULTS: A difference in gender distribution was seen with 12 males and 26 females in the aged group and 35 males and 27 females in the non-aged group (p<0.05). The mechanism of injury for the aged group in decreasing order was pedstrian accidents, falls, and passenger accidents while it was passenger accidents, pedestrian accidents, and falls for the non-aged group (p<0.05). Level of severity was higher in the non-aged group for fracture type, ISS, Glasgow Coma Scale, intensive care unit admission, and hospitalization duration. However, when ISS was greater than 15, this was seen in the aged group with also a higher mortality rate in the same group. CONCLUSION: Education and prevention, particularly about gender distribution and mechanism of injury, of pelvic fractures in the aged population are needed, and because of the potential seriousness of fractures in the elderly, active assessment and treatment are also necessary.
Aged ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Medical Records ; Pelvic Bones

Aortic interruption is a very rare disease that can be classified into congenital and acquired aortic interruption. Congenital aortic interruption generally implies an interruption of the aortic arch and no case of congenital abdominal aortic interruption has been reported. Acquired aortic interruption, on the other hand, can be caused by atherosclerosis, thrombosis, saddle embolism, and arteritis such as Takayasu arteritis. We experienced a case of congenital abdominal aortic interruption accompanied by one well-developed collateral flow presented with secondary hypertension in a 28-year-old female patient.
Adult ; Aorta, Abdominal ; Aorta, Thoracic ; Arteritis ; Atherosclerosis ; Embolism ; Female ; Hand ; Humans ; Hypertension* ; Rare Diseases ; Takayasu Arteritis ; Thrombosis

OBJECTIVE: The aim of this study was to investigate the clinical significance of myocardial injuries in patients with nontraumatic intracranial hemorrhage by identifying the occurrence of myocardial injury and defining its correlation with subsequent cardiovascular events. SUBJECTS AND METHODS: One hundred twenty-four patients with nontraumatic intracraninal hemorrhage presented to the emergency department within six hours from onset of symptoms were enrolled. Brain CT, serial electrocardiography, and echocardiography were done at the emergency center. Blood samples for troponin I and creatine kinase(CK)-MB were drawn immediately and eight hours after admission. Troponin I and CK-MB were measured using a chemiluminescent immunoassay, respectively. RESULTS: Electrocardiographic and echocardiography abnormalities were found in 65 cases(52.4%) and 21 cases(17%), respectively. Serum troponin I and creatine kinase-MB were increased in 35 cases (28.2%) and in 58 cases(46.8%), respectively. Abnormal findings of echocardiography and ECG, as well as elevated levels of serum troponin I and creatine kinase-MB, were associated with an increased risk of cardiovascular event and survival. Logistic regression analysis revealed that an abnormal echcocardiographic finding and elevation of serum troponin I were factors associated with the occurrence an adverse cardiovascular event and that electrocardiographic abnormalities and initial mental status were factors associated with poor prognosis. CONCLUSION: This study reveals that actual myocardial injury develops in a significant proportion of patients with nontraumatic intracranial hemorrhage and that the development of the myocardial injury is associated with an adverse cardiovascular event that occurs during admission.
Brain ; Creatine ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Immunoassay ; Intracranial Hemorrhages ; Logistic Models ; Prognosis ; Troponin I

Glechoma longituba is a common medicinal plant that is common in wet and sunny land. This plant is used to treat various illnesses including jaundice and edema. But, ingestion of the plant can cause severe pain and swelling on lip and mouth. We experienced three cases that had oral pain and sensory change after ingestion of G. longituba, which we report with a literature review.
Eating ; Edema ; Jaundice ; Lamiaceae ; Lip ; Mouth ; Paresthesia ; Plants ; Plants, Medicinal

PURPOSE: Radiological readings of possible or suspicious appendicitis are often unhelpful for clinicians, and normal readings may be misleading if the patient has appendicitis. We conducted a retrospective study to determine whether the efficiency of computed tomography (CT) or ultrasonography (USG) in diagnosing acute appendicitis is altered by clinical manifestations. METHODS: Data were collected from all the pathologicallyproven acute appendicitis patients who underwent CT or USG and subsequently had appendectomy between January 2009 and March 2010 at Kangwon National University Hospital. We classified radiological findings of "compatible with" and "probable" appendicitis as "highly efficient" and "possible" or "suspicious" appendicitis and "normal appendix" as "less efficient." The following clinical manifestations were included: duration of the chief complaint prior to performing CT or USG, right lower quadrant pain, pain migration, body temperature, abdominal tenderness, rebound tenderness, muscle guarding, wall rigidity, white blood cell count, percentage of polymorphonuclear cells, and C-reactive protein level. RESULTS: A total of 202 patients underwent appendectomies after imaging studies (37.2+/-20.3-years-of-age; male-to-female ratio, 1.08). Of these, 154(76.2%) received CT, 44 (21.8%) received USG, and four (2.0%) received magnetic resonance imaging. Radiological findings were highly efficient in 155 cases (76.7%) but less efficient in 47 cases (23.3%). Multiple logistic regression analysis demonstrated that the absence of pain migration was related to less efficient results (adjusted odds ratio, 3.26; 95% confidence interval, 1.16-9.12). CONCLUSION: The 'efficient' sensitivity of CT or USG in diagnosing acute appendicitis is low in the absence of a history of pain migration.
Appendectomy ; Appendicitis ; Body Temperature ; C-Reactive Protein ; Humans ; Leukocyte Count ; Logistic Models ; Magnetic Resonance Imaging ; Muscles ; Odds Ratio ; Reading ; Retrospective Studies

BACKGROUND: Recently, there has been an increase in acute poisonings in the elderly, which may be associated with attempts at suicide. The purpose of this study was to compare and analyze the clinical aspects and outcomes of acute poisonings in aged individuals with those of younger individuals. METHODS: We performed a retrospective analysis of 207 patients seen in the emergency department (ED) with acute poisoning from January 2009 to December 2010. Two groups were created, >65 years and <65 years. The following were carefully compared-annual frequency, gender distribution, cause of poisoning, poisoning substance, motive for suicide, past psychiatric history, psychiatric interview, psychiatric diagnosis, disposition after ED visit, disposition after admission, poisoning severity score (PSS), duration of hospitalization, intensive care unit (ICU) admission rate, and mortality. RESULTS: The annual frequency was 0.1% in the >65 group and 0.3% in the <65 group, 0.4% in total. The cause of poisoning was accidental more often in those >65 years than in those <65 years. As motive for suicide, health problem was cited more often in the older group (p=0.000). The older group had fewer interviews with psychiatrists and were more often diagnosed with depressive disorder (p=0.010, p=0.041, respectively). PSS and mortality were higher in the older group (p=0.002, p=0.010, respectively). CONCLUSION: A better understanding for the cause of poisonings and the poisonous substance used in the aged population is needed. And because of the more serious effects of acute poisonings to the elderly patient, they should readily receive regular comprehensive care including psychiatric care.
Aged ; Depressive Disorder ; Emergencies ; Hospitalization ; Humans ; Intensive Care Units ; Mental Disorders ; Psychiatry ; Retrospective Studies ; Suicide