BACKGROUND: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). METHODS: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. RESULTS: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. CONCLUSIONS: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.
Accidents, Traffic ; Bone Matrix ; Clavicle* ; Fracture Fixation ; Fracture Healing ; Humans ; Retrospective Studies

Epidural hematoma after epidural catheterization is very rare but one of serious complications. Although true incidence and origin is unknown yet, coagulopathies and anticoagulant therapy are predominant risk factors. Other risk factors are NSAIDs treatment and ankylosing spondylitis. We experienced a case of epidural hematoma without any risk factors after epidural catheterization for postoperative pain control. We performed epidural catheterization before operation and postoperatively the patient received continuous epidural infusion for postoperative pain control. On the first operative day, the patient was noted to have developed complete paraplegia and hypoesthesia below L1 and anesthesia below L2 level. Immediately after noting we performed TL-spine MRI and epidural hematoma at T10 level was diagnosed and treated by decompressive laminectomy. But she has not fully recovered yet.
Anesthesia ; Anti-Inflammatory Agents, Non-Steroidal ; Catheterization* ; Catheters* ; Hematoma* ; Humans ; Hypesthesia ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Pain, Postoperative ; Paraplegia ; Risk Factors ; Spondylitis, Ankylosing

Spontaneous intracranial hypotension (SIH) is an uncommon disease which present as a spontaneously occurring postural headache. Diagnosis is supported by a low CSF pressure by lumbar puncture, diffuse dural enhancement on gadolinium-enhanced brain MRI, or by a CSF leakage site on a radioisotope cisternography or by computed tomographic myelography. Usually SIH treatment is conservative but often requires caffeine, steroids, continuous epidural saline infusion and an epidural blood patch. The most important complication of SIH is bilateral subdural hematoma (SDH), because it may require urgent neurosurgical intervention. We experienced two-cases of SIH with SDH treated with an epidural blood patch, but subdural hematoma increased after radioisotope cisternography, so burr hole drainage was performed with another epidural blood patch.
Blood Patch, Epidural ; Brain ; Caffeine ; Diagnosis ; Drainage ; Headache ; Hematoma, Subdural* ; Intracranial Hypotension* ; Magnetic Resonance Imaging ; Myelography ; Spinal Puncture ; Steroids

No abstract available.
Angiofibroma* ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Sirolimus* ; Tuberous Sclerosis*

This study is a methodical research to develop a health behavior assessment scale for patients with rheumatoid arthritis, and to test the validity and reliability of the instrument. The research procedure was as follows; 1) The first step was to develop conceptual framework based on a comprehensive review of the literature, in-depth interviews patients with rheumatoid arthritis. This conceptual framework was organized in eight dimensions; pain management, exercise, rest, diet control, active committment, self-management, positive thinking, interpersonal maintenance. Initially 56 items were selected from 164 statement. 2) These items were reviewed by panel of eight specialists and the Index of Content validity (CVI) was calculated, and forty six items were selected which met more than 70% on the CVI. 3) 174 rheumatoid arthritis pateints were interviewed, and data was gathered from Jan. 25 to Feb. 18, 1999 for test reliabilities and validities of the scale. The item analysis was carried out and 40 items were selected. Factor analysis by varimax rotation was carried out to test construct validity. The internal consistency by chronbach's alpha was calculated. The findings were as follows; 1) Item analysis and factor analysis were carried out to test the validity of the health behavior assessment scale. The item analysis was based on the corrected item`s to total correlation coefficient (.30 or more), and information about the alpha estimate. However, this was only if this item was deleted from the scale. As a result of the item analysis, forty items were selected. Thirty items were selected by a initial factor analysis by varimax rotation, and ten items were deleted because of factor complexity. In the secondary factor analysis, eight factors were labled as 'positive thinking', 'exercise', 'rest', 'pain management', 'active committment', 'self-management', 'diet control', and 'interpersonal maintenance', each similar with the conceptual framework. 2) Chronbach's alpha coefficient to test reliability of the scale was. 903 for total the thirty items. The Scale for assessing health behavior developed in this study was identified to be a tool with a high degree of reliability and validity. Therefore this scale can be effectively utilized for assessment in the health behaviors of the patients with rheumatoid arthritis.
Arthritis, Rheumatoid* ; Diet ; Health Behavior* ; Humans ; Pain Management ; Reproducibility of Results ; Self Care ; Specialization ; Thinking

No abstract available.
Humans ; Stenotrophomonas maltophilia*

No abstract available.
Neurofibromatoses* ; Neurofibromatosis 1* ; Neurofibromin 1 ; Vitiligo*

Neurenteric cyst(enterogenous cyst) is a rare congenital lesion, usually affecting the lower cervical or upper thoracic areas, and its occurrence in cranial vault is even rarer. We present a patient with intracranial neurenteric cyst anterior to the pons and medulla oblongata. A 40-year old man presented with two-month history of occipital headache and facial spasm. The cyst was decompressed via far lateral suboccipital approach, and the patient recovered without permanent neurological deficits. Features on imaging studies and histological findings are discussed with the review of the literatures.
Adult ; Cranial Fossa, Posterior* ; Headache ; Humans ; Medulla Oblongata ; Neural Tube Defects* ; Pons ; Spasm

No abstract available.
Onycholysis*

No abstract available.
Carcinoma, Merkel Cell* ; Lymph Nodes* ; Lymphoscintigraphy* ; Neoplasm Metastasis*