PURPOSE: To evaluate arthroscopic findings of intraarticular lesions in patients with initial dislocation of the shoulder associated with a fracture of greater tuberosity and differences in lesions according to age. MATERIALS AND METHODS: The subjects were 13 patients who had received an arthroscopic evaluation from February 1997 to August 1998. Using 40 years of age after which rotator cuff tear frequently occurs at the time of traumatic dislocation as a base, we classified these cases into two groups: Group A (6 cases) under 40 years of age and group B (7 cases) over 40 years of age. As for arthroscopic findings, we investigated 8 items, including SLAP lesion, anterior labral tear above the mid-glenoid notch, capsular tear, Bankart lesion, Hill-Sachs lesion, glenoid cartilage fracture, rotator interval and cuff tear. RESULTS: Bankart lesion was observed in 50% of group A, but group B showed no Bankart lesion, but capsular tear without labral lesion was present in 71%, and rotator interval and cuff tear were observed in 29%. CONCLUSION: Many pathological findings were found with arthroscopy, and important pathological differences were observed between the two groups.
Arthroscopy ; Dislocations ; Fractures, Cartilage ; Humans ; Humerus* ; Rotator Cuff ; Shoulder Dislocation* ; Shoulder*

Background: Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report mortality trends for major causes of death. Methods: A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA. Results: The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death.Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3–5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5–3.5) than that in the general population. Conclusions The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.

BACKGROUND: Primary lymphoma of the gastrointestinal tract is an unusual disease for which the optimal management strategy has not been clearly defined. The role of surgery in the management of primary gastrointestinal lymphoma remains controversial. METHODS: We retrospectively reviewed the management and the outcome of 55 patients a diagnosis of gastrointestinal lymphoma who were treated at Kyung-Hee University Medical Center during the period 1986-1997. Thirty-seven of them underwent a resection for cure, and 23 patients of them underwent chemotherapy. 18 patients underwent chemotherapy only. Radiation therapy was excluded due to the small number of patients. Surgery consisted of wide local resection of the primary tumor (curative for stages I and II, and palliative for stages III and IV), and regional lymph nodes, with re-establishment of bowel continuity. Chemotherapy involved 6-10 courses of CHOP-B (cyclophosphamide, adriamicin, vincristine, prednisone, and bleomycin). Survival curves were calculated by using the Kaplan and Meier method. RESULTS: The mean age was 51 years (range: 3-82), the peak incidence of age was the fifth decades (34%), and the male-to-female ratio was 1.3:1. Common signs and symptoms at presentation were abdo minal pain (n=46), palpable mass (n=28), nausea/vomiting (n=26), and weight loss (n=18). The diagnostic sensitivities of ultrasound, contrast radiography, endoscopic biopsy, and computed tomography were 52%, 57%, 76%, and 78%, respectively. The primary tumor sites were the stomach (n=18), the terminal ileum & cecum (n=15), the small bowel (n=13), and the large bowel (n=9). The respective cumulative overall 5-year survival rates for stage I, II, III tumors were 89%, 74%, and 43% (p<0.05). The respective overall 5-year survival rate for resection only, resection with chemotherapy, and chemotherapy only were 100%, 78%, and 40% (p<0.05). By the Kaplan-Meier method, the prognostic factors of survival were stage and curative resection (p<0.05). CONCLUSION: A curative resection in a stage I, II lymphoma confined to the gastrointestinal tract and to regional involvement may improve patient survival.
Academic Medical Centers ; Biopsy ; Cecum ; Diagnosis ; Drug Therapy ; Gastrointestinal Tract* ; Humans ; Ileum ; Incidence ; Lymph Nodes ; Lymphoma* ; Prednisone ; Radiography ; Retrospective Studies ; Stomach ; Survival Rate ; Ultrasonography ; Vincristine ; Weight Loss

Mesenchymal chondrosarcoma is a rare tumor occurring in both bone and soft tissues and exhibits characteristics of a highly malignant tumor. The authors experienced a case of mesenchymal chondrosarcoma ocurring in a 33-year-old man, which had invaded the soft tissues of the chest wall and had been incompletely removed, and recurred in the adjacent T10 vertebra 4 years later. The patient presented with severe back pain and paraparesis at admission. Radiographic studies of the vertebra showed an aggressive osteolysis of the vertebral body, pedicle, lamina, compression of the spinal cord, and soft tissue invasion. The tumor was totally removed by an anterior and posterior combined approach. The removed vertebral body was replaced with a titanium mesh cage, and the thoracic spine was stabilized by both anterior and posterior fixations with instruments. The pathological and the clinical characteristics of mesenchymal chondrosarcoma are discussed.
Adult ; Back Pain ; Chondrosarcoma, Mesenchymal* ; Humans ; Osteolysis ; Paraparesis ; Spinal Cord ; Spine* ; Thoracic Wall ; Titanium

BACKGROUND: Thyrotropin-secreting pituitary adenoma is an uncommon disease and about 150 cases has been reported in the world literature. In Korea, only seven cases were reported as yet. The authors recently experienced four cases of TSH secreting pituitary tumor and analyzed the clinical characteristics and treatment outcomes of TSH-secreting tumors in Korean. METHODS: We analyzed clinical records of the four cases who had been recently treated at Asan Medical Center and the Korean literature which deals with the previously reported seven cases of TSH-secreting pituitary tumor. RESULTS: The average age at diagnosis was 37 years (ranging from 11 to 55 years). Four were men and seven were women. After the detection of hyperthyroidism, TSH-secreting pituitary adenoma was diagnosed 3.6 years later on the average. Ten patients presented with hyperthyroidism, but one had primary hypothyroidism. Typical features of acromegaly were observed in two patients. Visual disturbance was present in three cases, and galactorrhea was present in one case. Serum TSH concentrations ranged from 1.5 to 42.5uIU/mL showing mildly elevated or unsup-pressed TSH levels despite of elevated serum thyroid hormone concentrations. Among six cases in whom a-subunit level was measured, five showed elevated a-subunit level and a-subunit/TSH molar ratio. Two of 11 cases had microadenoma and the remainder had macroadeno#ma. Immunohisto-cheical studies were done in eight cases and revealed that three were positive for TSH only and five patients were positive for multiple hormones. Eight patients underwent transsphenoidal pituitary surgery and seven (88%) of them were cured. External irradiation or octreotide was used as adjunctive treatment in three cases. After treatment, TSH levels decreased in all six patients studied, hyperthyroidism was eliminated in all eight patients studied and visual disturbance was improved in two patients. CONCLUSION: Clinical characteristics of TSH-secreting pituitary adenoma in Koreans were similar with world literature, but were more common in women, had less visual disturbance and better surgical results. Diagnosis was commonly delayed for several years. TSH-secreting pituitary adenoma may be diagnosed more frequently and earlier with widespread use of sensitive TSH assay and early and proper diagnosis would lead proper treatments with improved outcome.
Acromegaly ; Asian Continental Ancestry Group ; Chungcheongnam-do ; Diagnosis ; Female ; Galactorrhea ; Humans ; Hyperthyroidism ; Hypothyroidism ; Korea ; Male ; Molar ; Octreotide ; Pituitary Neoplasms ; Pregnancy ; Thyroid Gland

Factor Vll deficiency has an estimated incidence of 1/500,000 in the general population and autosomal recessive pattern of inheritance. Factor Vll deficiency is characterized by prolonged prothrombin time (PT), and normal activated partial thromboplastin time (aPTT) and bleeding time (BT). Definite diagnosis of this condition requires a specific Factor Vll assay. The clinical features are variable and do not always correlate with the Factor Vll level. We experienced a case of Factor Vll deficiency presenting as hemarthroses in a 2-years-old girl, whose chief complaint was pain, swelling of right knee joint and limping gait. The laboratory findings were prolonged PT and prominent deficiency of factor Vll. So, we report a case of Factor Vll deficiency with a brief review of the related literature.
Bleeding Time ; Diagnosis ; Female ; Gait ; Hemarthrosis* ; Humans ; Incidence ; Knee Joint ; Partial Thromboplastin Time ; Prothrombin Time ; Wills

Factor Vll deficiency has an estimated incidence of 1/500,000 in the general population and autosomal recessive pattern of inheritance. Factor Vll deficiency is characterized by prolonged prothrombin time (PT), and normal activated partial thromboplastin time (aPTT) and bleeding time (BT). Definite diagnosis of this condition requires a specific Factor Vll assay. The clinical features are variable and do not always correlate with the Factor Vll level. We experienced a case of Factor Vll deficiency presenting as hemarthroses in a 2-years-old girl, whose chief complaint was pain, swelling of right knee joint and limping gait. The laboratory findings were prolonged PT and prominent deficiency of factor Vll. So, we report a case of Factor Vll deficiency with a brief review of the related literature.
Bleeding Time ; Diagnosis ; Female ; Gait ; Hemarthrosis* ; Humans ; Incidence ; Knee Joint ; Partial Thromboplastin Time ; Prothrombin Time ; Wills

PURPOSE: To prepare the appropriate guideline in choosing the internal fixatives for the intertrochanteric fractures of the femur in the elderly. MATERIALS AND METHODS: We reviewed 95 cases of intertrochanteric fractures of the femur from January, 1999 to December, 2003. We fixed the fracture with Proximal Femoral Nail in 37 cases (PFN group), Dynamic Hip Screw in 56 (DHS group), Dynamic Condylar Screw in 2 cases (DHS group). We reviewed operation time, blood loss during operation, changes in neck-shaft angle and sliding of lag screw. RESULTS: There were no significant differences in the parameters between the 2 groups in stable fracture. In unstable fractures, operation time in PFN group and DHS group revealed 103.9 and 128.2 minutes respectively; mean amount of blood loss during operation revealed 523.2 and 573.1 ml respectively. Mean changes in the neck-shaft angle at final follow-up in PFN group and DHS group revealed 4.6 degrees and 4.1 degrees; sliding of lag screw averaged 3.4 and 6.5 mm respectively. Among the DHS group, cases of additional fixation with trochanteric supporting plate revealed 3.1 degrees of changes in neck-shaft angle and 4.2 mm of lag screw sliding. CONCLUSION: In cases of stable fractures, any fixative might suffice. In cases of unstable fractures, there were no significant differences in results of treatment between these two groups, however, PFN group revealed shoter operation time and less blood loss during operation. It seemed to be necessary to apply additional fixation with trochanteric supporting plate when using DHS in unstable cases.
Aged* ; Femur* ; Fixatives* ; Follow-Up Studies ; Hip ; Hip Fractures* ; Humans

Infectious complications are common causes of morbidity in renal transplant recipients. To date, only two cases of retroperitoneal abscess caused by Norcardia asteroides and Mycobacterium fortuitum were reported in renal transplant recipients in the literature. We report a case of retroperitoneal abscess caused by gram negative bacilli-Citrobacter freundi, Klebsiella pneumoniae. The patient was admitted to the hospital due to flank pain. Abdominal CT scan and CT scan-guided aspiration confirmed retroperitoneal abscess. It is likely that the abscess in our patient was related to the anti-rejection treatment which included high-dose steroids, and mycophenolate mofetil. To our knowledge, this is the first report of retroperitoneal absces caused by gram-negative bacilli.
Abscess* ; Citrobacter* ; Flank Pain ; Humans ; Kidney Transplantation ; Klebsiella pneumoniae ; Klebsiella* ; Mycobacterium fortuitum ; Steroids ; Tomography, X-Ray Computed ; Transplantation

Subclavian catheters were used in the treatment of chronic renal failure patients waiting for the maturation of AV fistula. But, it sometimes causes fatal complications. Of these, massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but causes very serious complication. Most of patients with hemothorax are successfully treated with conservative treatment(i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy) but it sometimes needs surgery. We recently experienced a case of ARDS complicated by hemothorax which was successfully treated with thracooscopic drainage. We reviewed the pathogenesis of ARDS by hemothorax and suggested the guidlines for the treatment of massive hemothorax using video-assisted thoracoscopic surgery.
Catheterization ; Catheters* ; Drainage ; Fistula ; Hemorrhage ; Hemothorax* ; Humans ; Kidney Failure, Chronic ; Pleural Cavity ; Subclavian Vein ; Thoracic Surgery, Video-Assisted