It is socially fortunate that there is little chance in the civil hospital to experience the victims of high velocity missiles. However it is reasonable thought to educate doctors about the gunshot and explosive injuries who might be mobilized in emergency condition. Authors have experiences to treat the high velocity missile wounds. In order to provide valid data to be an educational material, we clinically analyzed 41cases of those injuries who were treated at the Capital Armed Forces General Hospital from 19xx to 19xx. The results obtained were as follows: 1. In 15 cases there were only soft tissue injuries, The remaining 26 cases had the bone injuries and six of them had two injury sites. 2. In 28 cases the lower extremities were injuried, and they out-numbered the injury of upper extremities. The most frequent site of injuries was the thigh (31.7%). 3. Most common associated injuries were the periphenal nerve injuries, which numbered 10 cases. 4. The early operative treatments were given in 5 out of 32 cases having bone injuries. And the secondary operations, including bone graft and intemal fixation, had to be done in 10 out of the remaining 27 cases due to delayed union or nonunion. 5. There was no infection in cases having only the soft tissue injuries. But the localized osteomyelitis occurred in 4 cases among the cases having bony injuries. 6. Factors affecting the result of high velocity missile wounds were presence of bony involvement, site and extent of injuries, associated thoracoabdominal injuries and presence of peripheral nerve injuries and infection. 7. The evacuation time, chance of early adequate wound management, site of injury and extent of injury were the important factors in deciding the method of treatment. We suggest that the more selective and aggressive measures should be taken in the management of bony injuries.
Arm ; Emergencies ; Extremities ; Hospitals, General ; Lower Extremity ; Methods ; Osteomyelitis ; Peripheral Nerve Injuries ; Soft Tissue Injuries ; Thigh ; Transplants ; Upper Extremity ; Wounds and Injuries

Dermoid cysts develop from sequestration of epithelium along lines of embryonic fusion.The most common locations are the lateral third of the eyebrows, nose, and scalp. These cysts are located in the subcutis; they are often adherent to periosteum, and may invade or erode underlying bane. A 34-year-old female presented with a solitary, skin colored, dome-shaped, child fistsized, subcutaneous mass on her right occiput. At operation, keratinous material was discharged and tufts of hair projected from opening of the cyst wall.The base of the cyst was firmly adherent to periosteum and diffuse depression with focal deep erosions of the outer table of skull was found.
Adult ; Child ; Cytochrome P-450 CYP1A1 ; Depression ; Dermoid Cyst* ; Epithelium ; Eyebrows ; Female ; Hair ; Humans ; Nose ; Periosteum ; Scalp ; Skin ; Skull*

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Asymptomatic Diseases ; Bacteria ; Estrogens, Conjugated (USP)* ; Fungi ; Heart Failure* ; Inflammation ; Myocardial Infarction ; Myocarditis* ; Rickettsia

BACKGROUND: An accurate and rapid method for specise identification of coagulase negative staphylococci(CNS) has been increasingly necessary for the clinical significance and planning the management of patients with staphylococcal infections. Recently, it has been reported that there is a highly conserved area on their 60KDa heat shock protein(HSP60) gene sequences between the interspecies of CNS and it can be amplified by a set of universal degenerate primer. This led us our attention to focus on whether the PCR-based RFLP method using Mse / restriction enzyme could be a useful tool for the species identification of CNS. METHODS: In the present study, we performed PCR-based RFLP analysis using a set of degenerate primers covering HSP60 and Mse / restriction enzyme on the reference strains and 25 clinical isolates(10 of S. epidermidis, 10 of S. haemolyticus, 4 of S. lugdunensis and 1 of S. warneri) which were previously identified by the API-STAPH, Vitek GPI card and/or with conventional biochemical test. RESULT: All the seven reference strains revealed that each strain has a distinct electrophoresed band patterns with combination of different number (up to 8) and size of fragments. And these distinct band patterns showed remarkable concordance with the seven reference strains and 25 clinical isolates. CONCLUSION: These result strongly suggest that the PCR-RFLP method using degenerate primers covering the HSP60 gene and Mse / digestion enzyme offer a convenient and accurate tool for species-specific identification of CNS.
Chaperonin 60* ; Coagulase* ; Digestion ; Heat-Shock Proteins* ; Hot Temperature* ; Humans ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Shock ; Staphylococcal Infections

PURPOSE: This study was performed to evaluate the efficiency of Platelet-rich plasma (PRP) for acceleration of bone healing process on allograft transplantation after curettage in benign bone tumor. MATERIALS AND METHODS: From December 2007 to February 2009, twenty-one patients who had benign bone tumor and underwent allograft transplantation after curettage were evaluated. Mean follow-up period was 14.6 months (range, 12-26 months). We compared with 13 cases of PRP group and 8 cases of non-PRP group in terms of size of lesion, bone resorption, amount of applied PRP and complications. The mean age at surgery was 23.6 years (range, 4-73 years). The most common diagnosis was simple bone cyst (7) followed by enchondroma (4), giant cell tumor (3), undifferentiated benign bone tumor (3) and so on. RESULTS: The mean size of lesion was 33.5 cm3 (range, 2.3-181.9 cm3) (29.4 cm3 in PRP group and 40.2 cm3 in non-PRP group). The mean volume of injected PRP was 7.4 cc (range, 3-12 cc). Bone union started at 3.0 months (range, 1.5-5.8 months) in PRP group and 5.3 months (range, 4-8 months) in non-PRP group. Three cases for each group were excluded due to recurrence and pathologic fracture. One patient had febrile episode 3 weeks later after surgery which subsided with antibiotics. CONCLUSION: The PRP could accelerate bone union in allograft transplantation after curettage of benign bone tumor. Furthermore, we expect that PRP can accelerate bone union in fracture or non-union.
Acceleration ; Anti-Bacterial Agents ; Bone Cysts ; Bone Resorption ; Chondroma ; Curettage ; Follow-Up Studies ; Fractures, Spontaneous ; Giant Cell Tumors ; Humans ; Platelet-Rich Plasma ; Recurrence ; Transplantation, Homologous ; Transplants

We report a case of 70-year-old woman who had bilateral coronary arteriovenous fistula(CAVF) and treated with percutaneous transcatheter coil embolization. Enlarged LV and reduced global LV systolic function were demonstrated on transthoracic echocardiography. Coronary angiography revealed a large coronary arteriovenous fistula from the right coronary artery to the main pulmonary artery and a small fistula from the left coronary artery to the main pulmonary artery. Percutaneous transcatheter coil embolization for CAVF from the right coronary artery to the main pulmonary artery was successfully performed with symptomatic improvement.
Aged ; Arteriovenous Fistula* ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Embolization, Therapeutic* ; Female ; Fistula ; Humans ; Pulmonary Artery

OBJECTIVE: Stenosis or herniated nucleus pulposus (HNP) occupying lumbar intracanal and foraminal area is an important cause of double radicular symptoms. Using the combined interlaminar and paraisthmic approach, we performed decompression surgery in patients with co-existing intracanal and foraminal lesions. The objective of this study is to describe usefulness and outcome of combined interlaminar and paraisthmic approach surgery and to analysis the cause of poor outcome. METHODS: Between Apr 2009 and Apr 2014, 78 patients (42 males and 36 females) with intracanal and foraminal lesions were enrolled in this study. Patients with a vacuum disc, spondylolisthesis, instability or an isthmic defect on the preoperative dynamic view radiograph were excluded from this study. All patients underwent surgery through a combined approach for discectomy and decompression. The outcome of surgery was evaluated and classified into excellent, good, fair and poor. RESULTS: The results were excellent in 53 patients, good in 9, fair in 6 and poor in 10 during the follow-up. The outcome of the combined approach was excellent to fair in 87% (68 of 78) patients in our study. In the poor outcome group, three patients complained of early-onset relapsed pain (<1 month) and another seven patients complained of delayed-onset pain (>3 months). CONCLUSION: Combined approach for both intracanal and foraminal area lesions may be useful if selectively performed on patients whose facet joint is relatively intact, and that it is worthy of consideration as an alternative to fusion surgery; however, further studies are needed.
Constriction, Pathologic ; Decompression ; Diskectomy ; Follow-Up Studies ; Humans ; Male ; Radiculopathy ; Spinal Stenosis ; Spondylolisthesis ; Vacuum ; Zygapophyseal Joint

PURPOSE: To evaluate the histological changes of the synovial membrane treated by 166Ho-Chitosan complex in collagenase induced arthritis of the knee in the rabbit. MATERIAL AND METHOD: Arthritis was induced in sixteen rabbits by intra-articular injection of 1mg collagenase II and then treated by intra-articular injection of 0.4mCi 166Ho-Chitosan complex 2weeks later. The radioisotope scan was checked in each rabbit for the distribution and extra-articular leakage of the 166Ho-Chitosan complex. The synovial tissues from the femorotibial joints were evaluated for serial histological changes 2, 4, 8, 12 weeks after the 166Ho-Chitosan complex injetion. RESULTS: Two weeks after 166Ho-Chitosan complex administration, inflammatory cells such as giant cells, lymphocytes, histiocyte, and fibroblasts appeared in the subsynovial stroma. The most synovial cells were necrotized. Four weeks after 166Ho-Chitosan complex administration, the inflammatory cells were decreased and many fibroblasts appeared on the subsynovial stroma. There was neovasculization in the synovial membrane 4 weeks after administration. The fibers of collagen were noticed in the synovial membrane and subsynovial stroma at 8 weeks. There was no synoviocyte in the synovium and the thickness of fibrosis was increased at 12weeks. There were fragmentation of the nucleoli of synoviocyte and endothelial cell on the transmission electron microscope (TEM) . CONCLUSION: This study suggests that the synovial membranes treated by 166Ho-Chitosan complex in the collagenase induced arthritis of the knee in the rabbit show early radiation damage and then subsequently develop the fibrosis, and no synovial cell regeneration was observed until 12 weeks.
Arthritis* ; Collagen ; Collagenases* ; Endothelial Cells ; Fibroblasts ; Fibrosis ; Giant Cells ; Histiocytes ; Injections, Intra-Articular ; Joints ; Knee* ; Lymphocytes ; Rabbits ; Regeneration ; Synovial Membrane

Cerebrotendinous xanthomatosis is a rare autosomal recessive disease that involves multiple organs, including the peripheral nervous system. The present study is the first to report the ultrasonographic findings of peripheral nerves in a patient with cerebrotendinous xanthomatosis. The patient presented with bilateral Achilles tendon enlargement and foot hypesthesia. Sonographic examination revealed hypoechoic, swollen peripheral nerves with enlarged bilateral Achilles tendons. Since the ultrasonographic findings revealed peripheral involvement, the diagnosis of cerebrotendinous xanthomatosis was established after laboratory and genetic studies along with clinical findings.
Achilles Tendon ; Diagnosis ; Foot ; Humans ; Hypesthesia ; Peripheral Nerves ; Peripheral Nervous System ; Polyneuropathies* ; Ultrasonography* ; Xanthomatosis, Cerebrotendinous*

BACKGROUND: Chronic shoulder pain draws the attention of doctors since it is a very common and serious disease at primary care level. The patients with this pain usually have a tendency to see many doctors, to take an abundance of medication, and sometimes to even suffer from depression. The pain and the symp- toms thereof often disable the patients in their every day lives. This study aims to seek the most efficient way of treatment between two therapies, namely, the existing drug therapy based on NSAID and the intramuscular stimulation(herein after IMS) therapy, which has re- cently been introduced, by comparing them in accordance with the following method. METHODS: The two therapies were applied for 3 weeks to female patients aged between 50 and 70 who had visited a hospital over a period of more than 3 months due to this type of pain. The patients were randomly given each therapy although the treatment and monitoring was done by the same physiotherapist. The monitoring was performed four times, the day before the start of treatment, 1 week, 2 weeks and 3 weeks after respectively. It measured the following elements: (1) pain scale by VAS(Visual Analogue Scale), (2) Sleep hygiene scale by VAS, (3) ROM(Range of Motion), Repeated measure ANOVA was used for analysis. RESULTS: While both therapies reduced the pain significantly during the 3 weeks, the study showed that IMS was more effective than the drug therapy in every element monitored(p<0.05). IMS turned out to be more effective the 1st week in every measured element, however, the drug therapy was more effective the 3rd week if compared to the 2nd week in terms of Sleep VAS score. CONCLUSION: IMS is more effective in easing chro nic shoulder pain since it has better results than NSAID in pain VAS score, sleep VAS score and ROM.
Chronic Pain ; Depression ; Drug Therapy ; Female* ; Humans ; Hygiene ; Physical Therapists ; Primary Health Care ; Shoulder Pain* ; Shoulder*