No abstract available.
Observer Variation*

PURPOSE: Adding anticholinergics to the treatment regimen of benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) elicits concern about deterioration of obstructive symptoms and the possibility of urine retention. We evaluated the risk factors increasing post-voiding residual (PVR) volume with long-term anticholinergics therapy of over 1 year in patients with BPH and OAB. MATERIALS AND METHODS: We selected patients with BPH and OAB from 2005 to 2007 who were more than 40 years old, were treated with alpha-blockers, had an International Prostate Symptom Score (IPSS) of 8 or more, and had an IPSS urgency score of 2 or more for OAB. The 98 patients selected were evaluated by age, diabetes mellitus, central nervous system (CNS) disease above the brain stem, prostate volume, uroflowmetry, PVR volume, prostate-specific antigen (PSA) level, and IPSS retrospectively. We evaluated risk factors for increasing PVR volume over 50 ml and 100 ml after treatment and analyzed the risk factors both univariately and multivariately. RESULTS: Age, diabetes mellitus, CNS disease, PSA level, prostate volume, initial PVR volume, peak urine flow rate (< or =15 ml/s), use of anticholinergics, and no use of 5-alpha-reductase inhibitor, which were regarded as risk factors for increasing PVR volume, were analyzed for their relation with PVR volume over 50 ml and 100 ml, respectively. Age, initial PVR volume, CNS disease, and use of anticholinergics were significantly associated with an increased PVR volume over 100 ml in the univariate analysis. In multivariate analysis, age, initial PVR volume, CNS disease, and use of anticholinergics remained significantly associated with an increased PVR volume over 100 ml. CONCLUSIONS: Age (> or=65 years), initial PVR (> or=50 ml), long-term therapy with anticholinergics of over 1 year, and CNS disease appear to be risk factors for increasing PVR volume over 100 ml in patients with BPH and OAB.
Brain Stem ; Central Nervous System ; Central Nervous System Diseases ; Cholinergic Antagonists ; Diabetes Mellitus ; Humans ; Multivariate Analysis ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Retention (Psychology) ; Retrospective Studies ; Risk Factors ; Urinary Bladder, Overactive

Pelvic fractures are associated with life-threatening injuries and high rates of morbidity and mortality. Management of internal blood loss associated with unstable pelvic ring injuries is paramount during the initial period. The reconstruction of the pelvic ring is of importance because it is a major contributor to the stability of the pelvic ring. We report the case of a 25-year-old man who had an unstable pelvic ring fracture combined with rupture of an obturator artery and had a successful and satisfactory treatment using minimally invasive surgery with percutaneous antegrade screw fixation.

Poland syndrome is a rare congenital disorder. It is characterized by unilateral chest wall hypoplasia, ipsilateral arm and hand abnormalities, and a variety of associated anomalies. It is suggested that the deformity has a sporadic and nongenetic nature. The main pathogenetic mechanism is the interruption of embryological blood supply to the subclavian artery with hypoplasia at the end of the 6th week of gestation. Most frequently involved muscle is the sternocostal portion of the pectoralis major muscle, with hypoplasia of breast and nipple, rib anomalies and unilateral brachysyndactyly. We experienced an unusual case of Poland syndrome which was detected by prenatally ultrasonographic evaluation at 36 gestational weeks. So, we report this case with a brief review of the literature.
Arm ; Breast ; Congenital Abnormalities ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Hand ; Nipples ; Poland Syndrome* ; Poland* ; Pregnancy ; Ribs ; Subclavian Artery ; Thoracic Wall ; Ultrasonography, Prenatal*

BACKGROUND: Most local anesthetics decrease neuromuscular transmission and potentiate the neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the influence of lidocaine on it effects rocuronium onset and intubation conditions in rapid-sequence intubation and to compare with those of succinylcholine. METHODS: Seventy five ASA physical status 1 and 2 patients were randomly allocated to three groups. Group S received succinylcholine (1.0 mg/kg), Group R received rocuronium (0.6 mg/kg) and additional lidocaine (1.5 mg/kg) was given intravenously prior to the administration of rocuronium 0.6 mg/kg in Group RL. Anesthesia was induced with midazolam 0.03 mg/kg, fentanyl 2microgram/kg, and thiopental 5 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxants and intubation conditions were evaluated. Neuromuscular blockades were assessed by single twitch responses of the adductor pollicis after ulnar nerve stimulation by accelerography (0.1 Hz, 0.2 ms supramaximal stimuli). RESULTS: The onset time of Group S (47.8+/-11.3) was shorter than those of Group R (87.8+/-30.2) and Group RL (75.4+/-21.5), but no differences was observed between the onset times of Group R and Group RL. Intubation conditions were good or excellent in all groups. CONCLUSIONS: Additional lidocaine to rocuronium neither influences intubation condition nor accelerate the rocuronium onset, and it is cannot be viewed as an alternative for succinylcholine in rapid-sequence tracheal intubation.
Anesthesia ; Anesthetics, Local ; Fentanyl ; Humans ; Intubation* ; Lidocaine* ; Midazolam ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve

The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.
Biology ; Humans ; Membranes ; Methods ; Osteogenesis, Distraction ; Surgeons ; Transplants ; Ultrasonography

Although perioperative pulmonary thromboembolisms (PTEs) are not rare, most anesthetists are unfamilar with the condition. We experience a case, which showed a sudden capnographic score drop, increased pumonary arterial pressure, and a D-shaped right ventricle by echocardiography in a femur surgery patient under general anesthesia. The case described provides an example of PTE and should remind anesthetists of the clinical course and treatment of this condition.
Anesthesia, General* ; Arterial Pressure ; Echocardiography ; Femur* ; Heart Ventricles ; Humans ; Orthopedics ; Pulmonary Embolism* ; Thromboembolism

Actinomycosis is a very rare infectious disease caused by Actinomyces, which are gram-positive, predominantly anaerobic, non acid-fast bacillus. Actinomyces are normal flora in the upper and lower aerodigestive tracks but can become pathogenic after mucosal injuries such as tooth extraction and trauma to the mouth or jaw. Actinomycosis of the maxillary sinus is very difficult to diagnose due to its low incidence and lack of characteristic clinical findings. We recently experienced a case of maxillary actinomycosis in a 78-year-old immunocompetent male who underwent endoscopic sinus surgery 10 months previously and a molar tooth extraction 3 months previously. CT scans showed soft tissue density with a focal calcification and flexible fiberscopy indicated a brown-colored mass at the maxillary sinus floor. The maxillary sinus lesion was removed by sinus irrigation through the ostium and histopathology confirmed sulfur granules compatible with actinomycosis. The patient was treated with a 6-month course of oral augmentin-clavulanate. A diagnosis of actinomycosis should always be considered in a patient with unilateral intractable maxillary sinusitis, focal calcification in CT scans, and a history of molar tooth extraction.
Actinomyces ; Actinomycosis ; Aged ; Bacillus ; Communicable Diseases ; Floors and Floorcoverings ; Humans ; Incidence ; Jaw ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Molar ; Mouth ; Sinusitis ; Sulfur ; Tooth Extraction ; Track and Field

Ipsilateral fractures of proximal femur with shaft and condylar region are very rare. Current concept of management is based on fixation of each fracture as independent entity using separate fixation modalities for proximal and distal parts of femur. However, we considered that antegrade femoral nailing with cephalomedullary screw fixation is a good option for ipsilateral multi-level femoral fractures. Here, we present an experience of satisfactory treatment for ipsilateral femoral neck fracture, subtrochanteric fracture, comminuted shaft fracture with supracondylar fracture following road traffic accident.

PURPOSE: We perform an analysis of infection risk factors for fracture patients and confirm that the risk factors reported in previous studies increase the risk of actual infection among fractured patients. In addition, injury severity score (ISS) which is used as an evaluation tool for morbidity of trauma patients, confirms whether there is a relationship with infection after orthopedic fracture surgery. METHODS: We retrospectively reviewed 1,818 patients who underwent fixation surgery at orthopedic trauma team, focused trauma center from January 1, 2015 to December 31, 2017. Thirty-five patients were infected after fracture surgery. We analyzed age, sex, open fracture criteria based on Gustilo-Aderson classification 3b, anatomical location (upper extremity or lower extremity) of fracture, diabetes, smoking, ISS. RESULTS: Of 1,818 patients, 35 (1.9%) were diagnosed with postoperative infection. Of the 35 infected patients, nine (25.7%) were female and five (14.0%) were upper extremity fractures. Three (8.6%) were diagnosed with diabetes and eight (22.8%) were smokers. Thirteen (37.1%) had ISS less than nine points and six (17.1%) had ISS 15 points or more. Of 1,818 patients, 80 had open fractures. Surgical site infection were diagnosed in 12 (15.0%) of 80. And nine of 12 were checked with Gustilo-Aderson classification 3b or more. Linear logistic regression analysis was performed using statistical analysis program Stata 15 (Stata Corporation, College Station, TX, USA). In addition, independent variables were logistic regression analyzed individually after Propensity scores matching. In all statistical analyzes, only open fracture was identified as a risk factor. CONCLUSIONS The risk factors for infection in fracture patients were found to be significantly influenced by open fracture rather than the underlying disease or anatomical feature of the patient. In the case of ISS, it is considered that there is a limitation. It is necessary to develop a new scoring system that can appropriately approach the morbidity of fracture trauma patients.