BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

The present study involves 667 patients of craniocerebral injury under 15 year old who were admitted to the Department of Neurosurgery, Yonsei Medical College and Wonju Christian Hospital from January, 1982 to December, 1983. The results of which were analyzed and evaluated as follows. 1) The proportion of male to female was 2 to 1, and one third of patients was from 2 to 7 years of age. 2) The most frequent cause of injury was traffic accident : crash injury by truck and taxi and the next was fall from height and which were the causes of three quaters of all the craniocerebral injury of children. 3) Accidents were most frequent in May, and their frequent hour was from 3 P.M. to 4 P.M. 4) In 546 cases(81.9%), the consciousness was lost at the moment of the accident, and the duration was considered to be correlated with the clinical severity. Vomiting was observed in 353 cases(52.9%), and the early seizure attack accured in 31 cases(4.6%). 5) On admission, 631 patients were G.C.S. 8 and over, 25 patients were G.C.S. between 5 and 7,11 patients were G.C.S. 3 or 4. Two thirds of mortality cases were observed in G.C.S. under 7. 6) On plain skull films, skull fracture was observed in 292(43.8%) cases. Among those, depressed skull fracture was observed in 57 cases, and compound comminuted depressed fracture in 21 cases. By brain CT scan, abnormal hemorrhagic density was observed in 126 cases(18.9%), which involves 65 cases of epidural hematoma and 14 cases of subdural hematoma. In 47 cases, the hemorrhagic density was observed in intracerebral, intraventricular or intracerebellar region. 7) Associated injury accompanied by head injury was observed in 102(15.3%) cases, and mandible fracture, with or without tooth fracture, clavicle fracture, femur fracture, tibia fracture in order of frequency. It is considered that associated injury was one of the major causes of long term hospitalization and complication. 8) Total mortality rate was 3.1%, and the postoperative mortality was 6.9%.
Accidents, Traffic ; Adolescent ; Brain ; Child* ; Clavicle ; Consciousness ; Craniocerebral Trauma* ; Female ; Femur ; Gangwon-do ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural ; Hospitalization ; Humans ; Male ; Mandible ; Mortality ; Motor Vehicles ; Neurosurgery ; Seizures ; Skull ; Skull Fracture, Depressed ; Skull Fractures ; Tibia ; Tomography, X-Ray Computed ; Tooth Fractures ; Vomiting

OBJECTIVE: A number of studies to improve in vitro culture conditions have been tried over past ten years by using co-culture system with helper somatic cells. However, the mechanism of coculture is poorly understood. This study was designed to understand the mechanism for the mode of actual action of co-culture system of ICR strain's 1-cell embryos with human oviduct epithelial cells by examining the effect of conditioned medium and contactless coculture using a cell culture insert on the embryo development and by measuring the level of superoxide anion from conditioned medium after co-culture. METHODS: ICR strain's zygote embryos were cultured in medium alone (control), coculture, conditioned medium, or contactless coculture system for 6 days. Conditioned media (CM) were prepared as following 5 groups. All CM were collected after culturing oviduct cells for 2 days. CM-1 was stored at -20degrees C until use, and CM-2 was prepared just before use as a culture medium. CM-3 was cocultured with embryos and retrieved just before use. CM-4 and CM-5 were derives from the microfilteration of CM-2 and CM-3, respectively, using Microcon-10 (10 kDa molecular weight cut-off). The percentage of the embryos developed to hatched blastocyst stage and the level of superoxide anion in supernatant from medium alone culture (control), coculture, and contactless coculture were measured. RESULTS: The rates of embryo development to the hatched blastocyst stage were significantly higher in coculture (43%) than in control (0%) (p<0.05). The CM-1 group had no embryo development since 2-cell embryonic stage, whereas the CM-2, CM-3, CM-4 and CM-5 groups had the improved development to 4 or 8 cell embryo stage, but the similar rate of development to hatched blastocyst compared to control. The effect of coculture on embryo develpment was disappeared in the contactless coculture group. The level of superoxide anion was significantly reduced in coculture group compared to control. CONCLUSION: It is concluded that the present coculture system overcomes the 2-cell block in vitro and improves the embryo development. This beneficial effect may be due to the direct cell-cell contact between embryo and helper cells or the removal of deleterious components from medium rather than the embryotrophic factors.
Animals ; Blastocyst ; Cell Culture Techniques ; Coculture Techniques* ; Culture Media, Conditioned ; Embryonic Development ; Embryonic Structures ; Epithelial Cells ; Female ; Humans ; Molecular Weight ; Oviducts ; Pregnancy ; Superoxides ; T-Lymphocytes, Helper-Inducer ; Zygote

A total of 72 cases of internal biliary drainage procedure has been done percutaneously at Departement ofRadilogy, Seoul Natinal Universtiy Hospital for recent 4 and half years since August 1981. Five different types ofinternal drainage including endoprosthesis were applied to various conditions with different obstruction levels.The different method of procedure in each type of internal drainage was described and the results were analysed.1. Among the clinical diagnosis in 72 cases, carcinoma of bile duct was in 37 cases as the most frequent one. Thenext was pancreas head carcinoma in 16 cases, followed by metastatic carcinoma and other disease. 2. Type Iinternal drainage, classical internal and external type with distal end in duodenum, was applied in 43 cases asthe most comon one. Type II, modification of type I with distal end in CBD, was applied in 17 cases. Type III,endoprosthesis distal end into duodenum, was applied in 7 cases. Type IV, endoprosthesis just across theobstruction in bile duct, was applied in 2 cases, Type V, combined type of any internal drainage with externaldrainage, was applied in 3 cases. 3. According to various obstruction level, prefered type could be selected. Forproximal obstruction type II and IV were preferred and for distal obstruction type III was chosen. However, type Icould be applied in any situation. 4. Early complication occurred in 9 cases(12.5%). Clinical imporvement withdecrease in bilirubin level was observed 17 of 21 cases in which follow-up data was available over 2 months. 5.Though the experience with those 72 cases it is recommended that appropriate type of internal biliary drainageshould be selected according to prognosis, obstruction level and clinical findings of each patient.
Bile Ducts ; Bilirubin ; Diagnosis ; Drainage ; Duodenum ; Follow-Up Studies ; Head ; Humans ; Methods ; Pancreas ; Prognosis ; Seoul

The author analyzed 153 cases of metastatic brain tumors, including diagnostic and therapeutic aspects, who had been admitted to Yonsei University College of Medicine and Jeonju Presbyterian Medical Center from January, 1976 to August, 1983. Results obtained are as follows: 1) Metastatic brain tumors constituted 16.5% of all brain tumors. 2) The majority of patients was in the age range of 41 to 60 years. 3) The most common primary tumor with brain metastasis was lung carcinoma(45.1%). 4) Headache was the single most common presenting symptom of cerebral metastasis. 5) The most frequent intracranial locations of metastatic brain tumors were parietal and frontal lobe. 6) The computed tomographic scan has become the single most valuable and accurate diagnostic tool for investigation of metastatic brain tumor. It was also important study in evaluating the effect of treatment. Multiplicity of lesions was an important diagnostic feature. Also densely enhancing, and homogeneous cortical mass surrounded by edema with finger-like projections was a common characteristic feature. 7) Combined therapy-surgical excision followed by whole brain radiotherapy and/or chemotherapy-had been shown to result in better prognosis than either modality alone. The 6 months survival rate of combined therapy was 66.7% and it was more efficient in prolonging the patient's quality of life than the other methods currently available. In some instances, admittedly rare, long-term survival could be achieved. When the metastatic mass was producing wevere neurological disability because of its location, and the prognosis was otherwise reasonable, significant palliation and improvement in the patient's neurological status could be secured by surgical removal.
Brain Neoplasms* ; Brain* ; Edema ; Frontal Lobe ; Headache ; Humans ; Jeollabuk-do ; Lung ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Quality of Life ; Rabeprazole ; Radiotherapy ; Survival Rate

43 patients with medulloblastoma of the posterior fossa were treated at the Department of Neurosurgery Yonsei University College of Medicine from 1981 to 1991. Major treatment were surgery, irradiation, chemotherapy or combination. Mean follow-up was 30 months(range, 1 to 120 months). Kaplan-Meier actuarial survival for all patients 59% at 3 years. Disease free survival was 53% at 3 years. Radiation and treatment period(before 1986 vs after 1986) affected outcome significantly. But other prognosic factors such as age, extent of surgical resection and chemotherapy did not affect outcome statistically. Follow-up more than 3 years showed very low recurrence rate.
Brain Neoplasms ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Medulloblastoma ; Neurosurgery ; Prognosis ; Recurrence

OBJECTIVE: This study aimed to investigate factors associated with incomplete occlusion of a cerebral aneurysm detected by indocyanine green videonangiography (ICG-VA) following aneurysm clipping. METHODS: We performed surgery on 135 patients with 151 intracranial aneurysms over a 1-year period. Included was an aneurysm more than 3 mm in size, the dome of which was sufficiently exposed and clipped permanently with one clip. Following ICG-VA, aneurysms were divided into a delayed-filling group and a no-filling group. Retrospective comparisons of the clip force, blade length and width, neck and dome size of the aneurysm, diameter of the parent artery, presence of atherosclerosis in the aneurysm neck, and systolic blood pressure during ICG-VA were made between the two groups. RESULTS: Eight of 31 aneurysms in 29 patients showed delayed filling of contrast. The clip force in the delayed-filling group was lower than in the no-filling group and the atherosclerosis of the aneurysm neck differed between the two groups (P<0.05). Blade width in the delayed-filling group was also significantly lower than in the no-filling group (P<0.05). Following adjustment for atherosclerosis of the aneurysm neck, clip force and blade width in the delayed-filling group was even lower. Incomplete passage of the clip tip was observed in four aneurysms, weak clip force in three, and a slit between clip blades in one. After booster clipping or clip reposition, neither aneurysm regrowth nor recanalization was observed during 6 months of follow-up. CONCLUSION: Closing force, blade width, tip position, and remnant slit are important for incomplete occlusion of an aneurysm.
Aneurysm ; Arteries ; Atherosclerosis ; Blood Pressure ; Humans ; Indocyanine Green ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies

OBJECTIVE: The purpose of this study was to determine any differences in outcome and patient satisfaction between endoscopic release (ECTR) and open carpal tunnel release (OCTR) in patients with bilateral carpal tunnel syndrome who underwent both techniques. METHODS: Seven patients with confirmed bilateral idiopathic carpal tunnel syndrome were randomized to undergo endoscopic release using a single portal Agee technique to one hand and a minimal open release to the other. Subsequent assessments were made at 0, 3, and 12 months after operation using a modified Levin scale. We also analyzed subjective and objective outcomes retrospectively, including the time to return to full activity, patient preference, cosmetic satisfaction, scar tenderness, and pillar pain. The pain was assessed using a visual analogue scale from 1 to 10. RESULTS: Based on the Levin scale, there were no significant differences between hands at any follow-up interval. At the three-month follow up, mean scale scores were lower in the ECTR group; however, the differences did not reach statistical significance. Cosmetically, all patients were satisfied with their scar irrespective of the technique. There were no statistical differences in terms of scar tenderness and pillar pain. CONCLUSION:ECTR did not show any significant advantage over short-incision OCTR. Therefore, the operator's experience and skill in using a certain method is important, regardless of which technique is used.
Carpal Tunnel Syndrome ; Cicatrix ; Cosmetics ; Follow-Up Studies ; Hand ; Humans ; Imidazoles ; Nitro Compounds ; Patient Preference ; Patient Satisfaction ; Retrospective Studies

OBJECTIVE: The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection. METHODS: A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion. RESULTS: The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04). CONCLUSION: Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.
Bone Resorption ; Brain ; Cohort Studies ; Decompressive Craniectomy ; Disease-Free Survival ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Retrospective Studies ; Transplants

A 62-year-old man with an infected periprosthetic femoral fracture, which occurred after a cementless total hip arthroplasty (THA) procedure, was treated utilizing an antibiotic-impregnated cement plate for internal fixation. Open reduction and internal fixation using a cable plate were initially attempted in his case, but a deep infection with methicillin-resistant staphylococcus epidermidis at the fracture site occurred 2 months after the initial cable plate procedure. Using an antibiotic-impregnated cement plate for internal fixation, one month later, the fracture had stabilized. Successful fusion occurred at 12 months after deploying the antibiotic-impregnated cement plate. This technique was useful in this complicated case because it facilitated the goals of eradicating infection, alleviating pain, and improving function.
Arthroplasty ; Femoral Fractures ; Hip ; Humans ; Methicillin Resistance ; Middle Aged ; Staphylococcus epidermidis