Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.
Acetabulum* ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteolysis ; Polyethylene ; Transplants

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

Isoniazid(Isonicotinic acid hydrazide) is an antimicrobial drug used since 1952 as a fast line agent for the prophylaxis and treatment of tuberculosis. Isoniazid is well known for problems in population having a high prevalence of isoniazid use for prophylaxis or treatment of tuberculosis. But intentional or accidental isoniazid overdose is uncommon. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5g of isoniazid. Doses larder than 30mg per kg often produce seizures. When ingested in amounts of 80-150mg per kg or more, isoniazid can be rapid fatal. 40-year-old woman having previous pulmonary tuberculosis ingested 7 gram of isoniazid(140mg/kg) to attempt suicide approximately 30 minutes prior to visit to our emergency medical center. She had recurrent generalized tonicclonic seizures and metabolic acidosis. We report one patient treated with pyridoxine, which was equivalent to the amount of isoniazid ingested and administered as a intravenous dose and oral dose.
Acidosis ; Adult ; Coma ; Eating ; Emergencies ; Female ; Humans ; Isoniazid* ; Prevalence ; Pyridoxine ; Seizures* ; Suicide ; Tuberculosis ; Tuberculosis, Pulmonary

Toxoplasma gondii is an obligate intracellular protozoan parasite, which invades a wide range of hosts including humans. The exact mechanisms involved in its invasion are not fully understood. This study focused on the roles of Ca2+ in host cell invasion and in T. gondii replication. We examined the invasion and replication of T. gondii pretreated with several calcium modulators, the conoid extrusion of tachyzoites. Calmodulin localization in T. gondii were observed using the immunogold method, and Ca2+ levels in tachyzoites by confocal microscopy. In light microscopic observation, tachyzoites co-treated with A23187 and EGTA showed that host cell invasion and intracellular replication were decreased. The invasion of tachyzoites was slightly inhibited by the Ca2+ channel blockers, bepridil and verapamil, and by the calmodulin antagonist, calmidazolium. We observed that calcium saline containing A23187 induced the extrusion of tachyzoite conoid. By immunoelectron microscopy, gold particles bound to anti-calmodulin or anti-actin mAb, were found to be localized on the anterior portion of tachyzoites. Remarkably reduced intracellular Ca2+ was observed in tachyzoites treated with BAPTA/AM by confocal microscopy. These results suggest that host cell invasion and the intracellular replication of T. gondii tachyzoites are inhibited by the calcium ionophore, A23187, and by the extracellular calcium chelator, EGTA.
Animals ; Calcium/*physiology ; Calcium Channel Blockers/pharmacology ; Calmodulin/antagonists & inhibitors ; Chelating Agents/pharmacology ; Hela Cells ; Host-Parasite Relations ; Humans ; Ionophores/pharmacology ; Research Support, Non-U.S. Gov't ; Toxoplasma/drug effects/pathogenicity/*physiology

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*

Arthroscopy assisted anterior cruciate ligament(ACL) reconstruction with the autogenous bone-patellar tendon-bone(BPB) graft showed more favorable results in the hand of experienced surgeon, but it requires long leaming curve for skillful techniques. On the contrary, open method is very easy to learn, but it needs more soft tissue dissection affecting rehabilitation and morbidity. Arthrotomy through the patellar tendon harvest site provide good surgical approach without supplementary incision, and hence short operation time and good clinical result can be expected. The purpose of this study is to introduce this technique and compares the results with arthroscopic one. We performed 67 cases of ACL reconstruction with autogenous BPB graft through the patellar tendon harvest site. We recorded and analysed the physical findings, Lysholm score and Cybex test at preoperative and postoperative 3, 6, 12 months. Average Lysholm score was 58.0 preoperatively and 90.5 at postoperative one year. Cybex test at one year follow-up showed decreased muscle strength of quadriceps, which was nearly the same result with arthroscopic technique. In conclusion, this technique provided similar excellent clinical results comparing with the arthroscopy assisted ones. Furthermore, this technique had merits of short learning curve and short operation time.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Arthroscopy ; Follow-Up Studies ; Hand ; Learning Curve ; Muscle Strength ; Patellar Ligament* ; Rehabilitation ; Transplants

Although spinal arachnoid cysts are relatively common findings observed incidentally in adults, they are much rarely reported in children. They are usually asymptomatic and are mainly located in the middle and lower thoracic regions. However, in rare circumstances, these cysts can cause mass effects that lead to neurologic symptoms. We report the rare case of a spinal extradural arachnoid cyst in a 12-year-old boy who showed signs and symptoms of cauda equina syndrome. Magnetic resonance imaging of the lumbar spine revealed a huge extradural arachnoid cyst extending from L2 to L5. Emergent laminectomy and repair of dural defect was performed after total resection of the extradural arachnoid cyst. There were no postoperative complications. Total recovery was achieved 6 months after surgery. Here, we report this rare case with a review of the literature.

BACKGROUND: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. METHODS: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. RESULTS: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34–74). Mean follow-up duration was 24 months (range, 12–40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. CONCLUSIONS: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.
Adhesives ; Arthroscopy ; Bursitis ; Female ; Follow-Up Studies ; Humans ; Joint Capsule Release ; Male ; Pathology ; Retrospective Studies ; Rotator Cuff ; Shoulder Joint ; Shoulder ; Synovitis ; Tears

Purpose: To investigate longitudinal changes in foveal retinal sublayer thicknesses during axial elongation. Methods: From February 2013 to September 2014, a prospective cohort was established comprising pediatric patients aged < 13 years exhibiting myopia with a spherical equivalent of less than -0.75 diopters (D). At each visit, the foveal retinal thickness was measured using spectral-domain optical coherence tomography and sublayers were distinguished as follows: 1) total retinal layer, 2) inner retinal layer, 3) retinal nerve fiber layer, and 4) ganglion cell-inner plexiform layer. The average thickness was calculated based on the nine subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) map and compared between the initial and final visits. Intra-individual correlations were analyzed using a linear mixed-effects model. Results: Twenty-three subjects (46 eyes) were observed for 2.7 ± 1.0 years. During that period, the myopia progressed (spherical equivalent of cycloplegic refraction: from -4.26 ± 2.34 to -6.09 ± 2.64 D; p < 0.001, paired t-test), and the axial length increased from 24.80 ± 1.28 to 25.58 ± 1.38 mm (p < 0.001, paired t-test). Nevertheless, the thicknesses of foveal retinal layers (total retinal layer, inner retinal layer, retinal nerve fiber layer, ganglion cell-inner plexiform layer) showed no significant change in any of the nine ETDRS subfields (all p > 0.05, linear mixed-effects model). Conclusions The foveal retinal sublayers maintained their thicknesses despite axial elongation, indicating that the foveal retinal structure, which is critical to visual acuity, is preserved even in elongated, myopic eyes.