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

BACKGROUND: The aim of this study was to analyze the questions in the shoulder and elbow section of the Korean Orthopaedic In-Training Examination (KOITE) and compare them with those of the US Orthopaedic In-Training Examination (US OITE). METHODS: Twenty-nine questions in the shoulder and elbow section of the KOITE from 2010 to 2014 were analyzed and compared with those of the US OITE (80 questions) by literature review. A thorough analysis of the contents was performed after categorizing as topics, diagnostic tools, treatment modalities, taxonomic classification, and references. RESULTS: The shoulder and elbow section of the KOITE was 5.8% weight which was similar to the US OITE (5.9%). The most commonly appearing topic was anterior labral injury (17.2%) on the KOITE compared to instability and arthritis (21.3%, each) on the US OITE. Magnetic resonance imaging was most frequently appeared imaging modality on the KOITE (41.0%) compared to the radiograph on the US OITE (43.0%). The Latarjet procedure was the most commonly asked treatment modality (22.2%) on the KOITE, whereas arthroplasty (33.3%) on the US OITE. The KOITE showed an even taxonomic classification distribution compared to the US OITE. Campbell's operative orthopaedics covered 96.6% questions as a reference on the KOITE compared to the Journal of Bone and Joint Surgery, American Volume on the US OITE, which covered 45.0%. CONCLUSIONS: This specific analysis shows us current trends of the shoulder and elbow section of the KOITE and it might be developed for use in the educational curricula for the trainee.
Arthritis ; Arthroplasty ; Classification ; Curriculum ; Elbow* ; Joints ; Magnetic Resonance Imaging ; Orthopedics* ; Shoulder*

No abstract available.
Hair*

PURPOSE: This study was conducted to investigate whether breast cancer with p53 protein overexpression (p53+) and loss of p16 protein expression (p16-) shows different body size indicator (height, weight, body mass index) associations as compared with breast tumors without p53 protein overexpression and the loss of p16 expression (p53-, p16+). MATERIALS AND METHODS: A hospital based case-control study was conducted among 92 women patients and 122 control subjects. The p53 protein overexpression and loss of p16 protein expression in the tissue sections of patients with breast cancer were determined using immunohistochemistry. RESULTS: A total of 26 tumors (28%) demonstrated p53 overexpression and 35 tumors (46%) showed abnormal p16 expression. The heaviest women had a higher risk with p53- and p16+ breast tumors. The odds ratios (OR) adjusted for age, menopausal status, smoking, and drinking revealed a significant gradient of increasing risk of breast cancer with increasing BMI in p53- and p16+ breast cancer. The adjusted ORs for the highest quintile of BMI was 8.51 with p53+ tumors and 14.2 with p53- tumors, and 55.6 with p16+ tumors and 3.72 with p16- tumors. p53 protein overexpression and the loss of p16 expression did not significantly correlate with nodal status, tumor size, estrogen or progesterone receptor status. CONCLUSION: The study concluded that a strong association between p53-/p16+ tumors and BMI suggests the occurrence of p53-/p16+ tumors is related with obesity as compared to p53-/p16+ tumors.
Body Mass Index* ; Body Size ; Body Weight ; Breast Neoplasms* ; Breast* ; Case-Control Studies ; Drinking ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Obesity ; Odds Ratio ; Receptors, Progesterone ; Smoke ; Smoking

No abstract available.
Down Syndrome* ; Humans ; Psoriasis*

It is well known that the presence of arachnoid cysts (ACs) in young patients is a risk factor for developing a chronic subdural hematoma (CSDH) after a minor head injury. Although there have been controversies with the treatment, most authors recommend only draining the CSDH if the AC is asymptomatic. This judgement is based on the facts that this surgical approach has shown good clinical outcomes, and the AC usually remains unchanged after the surgery. Our case demonstrates that the AC of a young patient who developed a CSDH after a minor head injury completely disappeared after a burr hole drainage of the CSDH. Although the chances of an AC disappearing are low, this case shows that an AC might disappear after only draining a CSDH when a rupture of the AC membrane is identified. In such cases, we recommend first draining only the CSDH for the treatment of AC-associated CSDHs.
Arachnoid Cysts ; Arachnoid ; Craniocerebral Trauma ; Drainage ; Hematoma, Subdural, Chronic ; Humans ; Membranes ; Risk Factors ; Rupture

For quality assurance purposes, the authors correlated aspiration cytology and subsequent tissue findings and examined the reasons for discrepancies. In three months from Jan. to Mar. 1996, 1,383 aspirations were performed, of which 285 (20.6%) had subsequent tissue diagnoses within two months. The aspiration sites were thyroid (483), lymph node (LN) (290), breast (250), soft tissue (154), liver (89), lung (49), salivary gland (26), pancreas (22), gallbladder (3), bone (3), joint (2), adrenal gland (2), scrotum (2), mediastinum (2), omentum (2), oral cavity (1), chest wall (1), and intraabdominal (1) and pelvic cavities (1). A total of 68 discrepancies were identified, and biopsies and smears from these cases were reviewed monthly. In 27 cases (40%), the discrepancy was attributed to sampling error. In five cases (9%), aspiration gave superior results with better sampling and preservation than biopsy. Thirty six cases (53% of discrepant cases) were errors in cytologic diagnosis. We categorized these discrepancies into "A", "B", and "C" ("A": minor disagreement with no affect on patient care, "B": minimal affect on patient care, "C": major affect on patient care), which were 9 (13%), 14 (21%) and 13 (19%) cases, respectively. In thirteen cases of category "C", there were eleven false negative and two false positive diagnoses. Eleven false negative cases included thyroid (3), lymph node (2), breast (2), bone (1), salivary gland (1), lung (1), and liver (1). Three cases of thyroid were papillary carcinomas diagnosed as nodular hyperplasia (1), occasional pleomorphic cells (1), and cystic change (1). Two breast cases of invasive ductal carcinomas were diagnosed as ductal hyperplasia. A malignant lymphoma was diagnosed as reactive hyperplasia and a metastatic carcinoma of LN was diagnosed as tuberculosis. Other cases were malignant tumors of bone, salivary gland, lung, and liver those were misinterpreted as benign lesion or normal. Of two false positive cases, one was nodular hyperplasia of thyroid diagnosed as papillary carcinoma and the other was normal islet cell of pancreas diagnosed as islet cell tumor. A continuous monitoring of laboratory performance is an essential component of the quality control and assurance, and the review of discrepant cases provides useful information for improvement of diagnosis.
Adenoma, Islet Cell ; Adrenal Glands ; Aspirations (Psychology) ; Biopsy ; Breast ; Carcinoma, Ductal ; Carcinoma, Papillary ; Diagnosis ; Gallbladder ; Humans ; Hyperplasia ; Islets of Langerhans ; Joints ; Liver ; Lung ; Lymph Nodes ; Lymphoma ; Mediastinum ; Mouth ; Omentum ; Pancreas ; Patient Care ; Quality Control ; Salivary Glands ; Scrotum ; Selection Bias ; Thoracic Wall ; Thyroid Gland ; Tuberculosis

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

PURPOSE: The aim of this study was to determine whether the enuresis subtype, on the basis of nocturnal hypercalciuria, can be generally accepted. MATERIALS AND METHODS: Since 2003, 58 children visited our clinic for nocturnal enuresis, and were enrolled in this study. Patients were followed to evaluate the treatment response after three months medical treatment. Patients were divided into 3 groups; group 1 had nocturnal polyuria, group 2 had non-nocturnal polyuria and group 3 did not have nocturnal enuresis. The urine creatinine, osmolarity and calcium were measured in urine obtained both during the day and night. Hypercalciuria was defined as a urinary calcium to urinary creatinine ratio greater than 0.20. The treatment response was measured as a full, partial or non-response in the nocturnal hypercalciuria and non-nocturnal hypercalciuric groups. Statistical evaluation was performed using Pearson correlation, chi-squared, Student's t-test (paired) and ANOVA tests. RESULTS: There were no significant differences in the calciuria to urinary creatinine ratios between the groups in the urine obtained during the night. There were no significant differences in urinary Ca/kg/12 hours between the groups, with the exception of a significant increase at night in group 1. There were no statistically significant correlations between nocturnal polyuria and nocturnal calciuria between the three groups. During the 3 months after medical therapy, there were no significant differences in the response rates between the nocturnal hyperclaciuria and non-nocturnal hypercalciuria groups. CONCLUSIONS: In this study, no evidence could be for hypercalciuria affecting nocturnal polyuria, including the treatment response results. Therefore, as the first diagnostic method of enuresis, the hypercalciuria measurement can not be recommended. Further study is necessary to classify the enuresis subtype on the basis of nocturnal hypercalciuria.
Calcium ; Child ; Creatinine ; Deamino Arginine Vasopressin ; Enuresis* ; Humans ; Hypercalciuria* ; Nocturnal Enuresis ; Osmolar Concentration ; Polyuria ; Prospective Studies*

No abstract available.
Angiotensin II* ; Angiotensins* ; Animals ; Hemorrhage* ; Rats*