BACKGROUND: It has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure. MATERIALS AND METHODS: From March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications. RESULTS: The most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered. CONCLUSION: Closed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital.
Catheterization, Central Venous ; Catheters ; Catheters, Indwelling ; Central Venous Catheters ; Humans ; Iatrogenic Disease ; Needles ; Pneumothorax ; Retrospective Studies ; Surgical Instruments ; Thoracostomy ; Treatment Failure ; Treatment Outcome

Although intramedullary nailing is mostly used in the management of fractures in the long bone shaft, plate fixation is still alternative option in periprosthetic or metaphyseal fractures. For the rigid fixation during plating, sometimes we need wiring. Many surgeons experience slippage of wire resulting in loss of rigid fixation because plate and wire is so slippery and the diameter of bone is changing by level especially in the metaphyseal area. Wiring plate(CHO plate) was designed to prevent slippage. This plate has transverse holes for wires between screw holes on traditionally used dynamic compression plate. Sixteen fractures of long bone shaft were fixed with wiring plate and 11 cases which were followed up for more than one year were evaluated. There were periprosthetic fractures(4 cases), spiral or butterfly fractures(4 cases) and fractures of poor bone quality(two cases of malignancy and one case of osteoporosis). Nine cases were successfully reduced and the healed without loss of fixation. In two cases, delayed union and nonunion were observed due to wire breakage with plate loosening. Preliminarily, wiring plate fixation can be used for the periprosthetic fracture and one of alternative option in butterfly or spiral fracture and fracture in osteoporotic bone or pathologic fracture.
Butterflies ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Periprosthetic Fractures

To determine size and shape discrepancy between the bone of Korean women and the prostheses in total knee arthroplasty, the height(antero-posterior length) and width(medio-lateral length) of the distal femur and the proximal tibia were measured at the bone resection level for 104 knees of 62 female patients who underwent primary total knee arthroplasty and compared with the same parameters of the total knee prostheses designed by five different companies. On the condition that the height of the prostheses matched with each cases of the bone were optimal, the difference in the width was evaluated, and the criteria of the discrepancy were overhang if the width of the prosthesis was larger than bone, optimal if width of the prosthesis was same or smaller and difference was within 5 mm, and down-size if smaller and difference was over Smm. In femoral prostheses, 34.6% of all were optimal, 13.1%, overhang and 52.3%, down-size. In tibial prosthesis, 54.1% of all were optimal, 13.9%, overhang and 32%, down-size. In conclusion, although further investigation for clinical application is needed, there were discrepancies in size and shape between the femur and tibia of Korean women and total knee prostheses and improvement in design should be considered.
Arthroplasty* ; Female ; Femur ; Humans ; Knee Prosthesis ; Knee* ; Prostheses and Implants* ; Tibia

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

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.
Anterior Cruciate Ligament* ; Arthroplasty ; Humans ; Joints ; Knee* ; Ligaments ; Osteoarthritis ; Osteophyte ; Radiography* ; Tomography, Emission-Computed, Single-Photon*

Polyacrylamide hydrogel is a widely used filler material in cosmetic procedures performed on the face and breasts. Recently, however, complications including inflammation, deformity, and pain have been reported. The present article addresses unregulated materials/products injected as dermal fillers. The authors report a case involving a 29-year-old woman who developed severe facial pain after undergoing a cosmetic procedure with injectable triamcinolone and hyaluronidase. Two months later, the pain spread to her upper and lower limbs, and abdomen, which eventually led to the the development and diagnosis of complex regional pain syndrome (CRPS) in the upper limbs. The authors hypothesize that CRPS in the upper limbs was responsible for the facial pain through sensitization of third-order neurons and the trigeminal nucleus caudalis extending to the upper cervical segments.
Abdomen ; Adult ; Breast ; Congenital Abnormalities ; Dermal Fillers ; Diagnosis ; Facial Neuralgia ; Facial Pain* ; Female ; Humans ; Hyaluronic Acid ; Hyaluronoglucosaminidase ; Hydrogel ; Inflammation ; Lower Extremity ; Neurons ; Triamcinolone ; Trigeminal Nuclei ; Upper Extremity*

Cervical cancer and its precursors are caused principally, if not exclusively, by HPV infection and HPV DNA is found in more than 90% of cervical cancers. Cervical cytology is limited by its false negativity and this may be supplimented by other adjunctive test such as HPV test. It is therefore important to explore the use of HPV DNA detection as a primary or supplementary screening method and to determine whether HPV typing can be used as a predictor of a lesion's clinical behavior. Cervical cytology and Hybrid Capture test for HPV detection were performed in 450 asymtomatic wornen visited Health Care Center in Kangnam St. Mary's Hospital,and none of whom was believed to have current cervical disease. The Papanicolaou cytology results were classified by The Bethesda System : 333(74.%) women were classified to within normal limit, 19(4.2%) benign reactive change, 38(8.4%) ASCUS, 59(13%) low grade SIL, and only one woman high grade SIL. Twenty five of 450(5.6%) women showed HPV infection by Hybid Capture test. Among 98 wornen with abnormal Papanicolaou cytology, 16(16.3%) women showed HPV DNA positivity. (continue)
Delivery of Health Care ; DNA* ; Female ; Humans* ; Mass Screening* ; Papilloma* ; Uterine Cervical Neoplasms

This study was performed to evaluate whether increasing hemoglobin before ascent by prophylactic erythropoietin injections prevents acute mountain sickness (AMS). This open-label, randomized, controlled trial involved 39 healthy volunteers with hemoglobin < or =15.5 g/dL who were divided randomly into erythropoietin (n=20) and control (n=19) groups. Epoetin alpha 10,000 IU injections were given weekly for four consecutive weeks. On day 1, and 7 days after the last injection (day 29), oxygen saturation (SaO2), and hemoglobin were measured. The subjects departed Seoul on day 30 and arrived at Annapurna base camp (ABC, 4,130 m) on day 34. AMS was diagnosed when headache and Lake Louise score (LLS) of > or =3 were present. Immediate descent criteria followed US Army recommendations. Two groups differ in hemoglobin levels on day 29 (15.4+/-1.1 vs 14.2+/-1.0 g/dL, P=0.001). At ABC, erythropoietin group had a significantly lower mean LLS, AMS incidence, and number of subjects who met immediate descent criteria. Multiple logistic regression analysis showed that SaO2<87% and control group, but not hemoglobin<15.0 g/dL, independently predicted satisfaction of immediate descent criteria. Erythropoietin-related adverse effects were not observed. In conclusion, erythropoietin may be an effective prophylaxis for AMS.(Clinical Trial Registry Number; NCT 01665781).
Acute Disease ; Adult ; Altitude Sickness/diagnosis/epidemiology/*prevention & control ; Blood Pressure/physiology ; Drug Administration Schedule ; Erythropoietin/*therapeutic use ; Female ; Headache/physiopathology ; Hemoglobins/analysis ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Oxygen/blood ; Questionnaires ; Recombinant Proteins/therapeutic use

BACKGROUND: Causative bacterial agents of infectious diarrheal disease were traditionally diagnosed by stool cultures. Stool culture, however, has a problem because of relatively low sensitivity and long turnaround time. In this study, we evaluated multiplex PCR applied on stool specimens directly to diagnose enteropathogenic bacteria. METHODS: From June to September 2009, 173 diarrheal stools submitted for stool cultures were tested by Seeplex(R) Diarrhea ACE Detection kit (Seegene, Korea) to detect 10 enteropathogenic bacteria. Specimens were cultured for Salmonella, Shigella, Vibrio, and Yersinia. Late 50 specimens were also cultured for Campylobacter. The specimens positive for verotoxin-producing Escherichia coli (VTEC) were further subcultured for detecting enterohaemorrhagic Escherichia coli O157:H7. Electronic medical records were reviewed for clinical and laboratory findings. RESULTS: Of 173 specimens, multiplex PCR and cultures identified enteropathogens in 36 (20.8%) and 8 specimens (4.6%), respectively. While multiplex PCR detected 5 Salmonella, 15 Campylobacter, 1 Vibrio, 4 Clostridium difficiles toxin B, 5 Clostridium perfringens, 1 Yersinia enterocolitica, 5 Aeromonas, and 2 VTEC, cultures detected 5 Salmonella, 1 Vibrio, 1 Y. enterocolitica, 1 Aeromonas, and 2 E. coli O157:H7. CONCLUSION: Multiplex PCR would be useful to detect Campylobacter, VTEC and C. perfringens, as well as have equivalent sensitivity to conventional culture for ordinary enteropathogens such as Salmonella, Shigella, Vibrio, Y. enterocolitica. Direct application of multiplex PCR combined with conventional cultures on stool warrants remarkable improvement of sensitivity to diagnose enteropathogenic bacteria.
Aeromonas ; Bacteria ; Campylobacter ; Clostridium ; Clostridium perfringens ; Diarrhea ; Dysentery ; Electronic Health Records ; Escherichia coli ; Multiplex Polymerase Chain Reaction ; Salmonella ; Shiga-Toxigenic Escherichia coli ; Shigella ; Vibrio ; Yersinia ; Yersinia enterocolitica

PURPOSE: To evaluate the changes in corneal keratometry (K) readings after corneal collagen cross- linking (CXL) using 20% alcohol in primary keratoconus and keratectasia after refractive surgery. METHODS: Twelve eyes of 10 patients with primary keratoconus and 3 eyes of 3 patients with keratectasia after refractive surgery were included in the present study. Best-corrected visual acuity (BCVA) and mean K, corneal astigmatism by corneal topography, and mean K, corneal astigmatism, and spherical equivalent (SE) by auto refractometer were evaluated at baseline, and 6 months postoperatively. Eight eyes of 7 patients were also evaluated 1 year postoperatively. RESULTS: Mean BCVA improved from log MAR 0.66 +/- 0.50 to log MAR 0.55 +/- 0.58 (p = 0.100) at 6 month after CXL. In corneal topography, mean K significantly decreased from 50.04 +/- 5.88 D to 49.18 +/- 6.15 D (p = 0.019), and corneal astigmatism slightly decreased from 5.33 +/- 4.47 D to 5.29 +/- 4.88 D (p = 0.755) at 6 months after CXL. According to the auto refractometer, mean K significantly decreased from 48.53 +/- 5.94 D to 47.95 +/- 5.79 D (p = 0.038), corneal astigmatism significantly decreased from 3.95 +/- 2.54 D to 3.52 +/- 2.40 D (p = 0.010), and SE significantly decreased from -6.25 +/- 3.45 D to -5.40 +/- 2.91 D (p = 0.037) at 6 months after CXL. Significant mean K and corneal astigmatism decreases in topography were also observed at 1 year after CXL. Complications related to CXL were not observed. CONCLUSIONS: CXL using 20% alcohol appears to be a safe and promising treatment modality with less corneal stromal damage in progressive primary keratoconus and keratectasia after refractive surgery.
Astigmatism ; Collagen ; Corneal Topography ; Eye ; Humans ; Keratoconus ; Reading ; Refractive Surgical Procedures ; Visual Acuity