BACKGROUND: We investigated the effectiveness of pain management and the adverse events of intravenous (IV) patient-controlled analgesia (PCA) after orthopedic surgery. METHODS: From September 2014 and August 2015, we performed a retrospective analysis of 77 patients who underwent orthopedic surgery of the shoulder or the elbow in our hospital. The composition of the intravenous PCA administered to the patients was as follows: 250 mg of dexketoprofen trametamol, 70 mg of oxycodone, and 0.6 mg of ramosetron, which were made up to 79 ml of normal saline. We evaluated and statistically analyzed the difference in the visual analogue scale (VAS) scores for pain at immediate postoperation, at 24 hours of PCA, at 72 hours of PCA, and after discontinuation of PCA and in the incidence of adverse events. RESULTS: We found that VAS score decreased for 3 postoperative days and that with discontinuation of IV PCA a meaningful change in VAS score was no longer seen. Of the 77 patients, 22 presented with adverse events (28.6%). We terminated IV PCA temporarily in the 21 patients who presented with adverse events; we terminated analgesia permanently in one patient (1.2%). Consequently, 76 of 77 patients carried out IV PCA till the designated period. CONCLUSIONS: Intravenous PCA after orthopedic surgery of the shoulder or the elbow may be accompanied with adverse events. Careful assessment of the patient and treatment of the adverse outcomes are key to a successful maintenance of PCA and to a successful management of postoperative pain.
Analgesia ; Analgesia, Patient-Controlled* ; Anti-Inflammatory Agents, Non-Steroidal ; Elbow* ; Humans ; Incidence ; Orthopedics ; Oxycodone ; Pain Management ; Pain Measurement ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; Shoulder*

PURPOSE: To evaluate the influence of postoperative tibiofemoral alignment on the clinical results and failure in patients who underwent unicompartmental knee athroplasty (UKA). MATERIALS AND METHODS: We reviewed 246 cases of medial UKA which were followed up for at least 5 years after the operation. The clinical results were compared between 5 groups classified according to the tibiofemoral angle that was measured at 3 months after surgery. We analyzed the relationship between the tibiofemoral alignment and the failure after UKA. RESULTS: The preoperative tibiofemoral angle was changed from 0.4degrees of varus to 5.4degrees of valgus after surgery and the average correction angle was 5.8degrees. During the follow-up, which averaged 7 years and 5 months, the knee score and function score were improved significantly in all groups regardless of the tibiofemoral angle (p<0.01). There were no significant difference between the groups in the clinical results (p>0.05). However, there were significant differences in the cumulative survival rate of implants between the groups and the highest rate was found in the group with a tibiofemoral angle of 4degrees to 6degrees of valgus (p<0.01). CONCLUSIONS: The tibiofemoral angle after UKA had no significant influence on the midterm clinical scores, but there was a significant relationship between the postoperative tibiofemoral angle and failure rate of implant.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Survival Rate

STUDY DESIGN: A case controlled study with prospective data collection. PURPOSE: To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF). OVERVIEW OF LITERATURE: DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount. METHODS: Patients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale. RESULTS: The subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment. CONCLUSIONS: DBM was not recognized to enhance auto-local bone with small amount.
Bone Matrix* ; Case-Control Studies ; Data Collection ; Humans ; Osteogenesis ; Prospective Studies ; Radiography ; Transplants*

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaingl, multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatations, biliary calculi. Dopper frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomotraphy(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated duets are another helpful diagnostic criteria and these findings are easily depicted on routine sonograms with color mapping.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Caroli Disease* ; Dilatation ; Fibrosis ; Gallstones ; Humans ; Pathology ; Polycystic Kidney Diseases ; Siblings ; Ultrasonography

BACKGROUND AND OBJECTIVES: Although the necessity of hearing aids as one of the rehabilitation methods is increasing, many hearing impaired persons are avoiding the use of behind-the-ear (BTE) hearing aids and prefer the complete-in-the-canal (CIC) hearing aids. CIC hearing aids have cosmetic and acoustic advantages but have problems of acoustic feedback and discomfort in wearing. Changes in the external auditory canal (EAC) by mandibular movements are a primary factor for the acoustic feedback and discomfort. The purpose of this research is to study the pattern of changes in the EAC by mandibular movement using the Korean population as subjects and to get basic data concerning the manufacture of impressions and shells for CIC hearing aids. MATERIALS AND METHODS: Subjects were 19 men with a fit external ear diameter to make CIC hearing aid. Impressions were made by taking 5 different conditions of jaw into consideration : fully opened state, 1/2 opened state, biting state, chewing state and resting state. Impressions were scanned at intervals of O.1mm using a 3D Laser digitizing system. We measured anterior to posterior (AP) width and superior to inferior (SI) height of each impression at the first bend, interbend and the 2nd bend of 5 conditions. RESULTS: Compared with the resting state, statistically significant changes in the AP width of the ear canal were observed at the interbend in the following order : fully opened jaw, 1/2 opened jaw (p <0.05), at 1st bend: 1/2 opened jaw (p<0.05). The 2nd bend biting state showed maximal AP width of the ear canal (p<0.05). The SI height of ear canal revealed statistically insignificant changes. CONCLUSION: We recommend making of ear impressions in the chewing state and shells to be supported at the interbend of the ear canal. The SI dimension of a shell tip should be more ground than AP dimension.
Acoustics ; Ear Canal* ; Ear* ; Ear, External ; Hearing Aids ; Humans ; Jaw ; Male ; Mandible ; Mastication ; Persons With Hearing Impairments ; Rehabilitation

BACKGROUND: We investigated the effectiveness of pain management and the adverse events of intravenous (IV) patient-controlled analgesia (PCA) after orthopedic surgery. METHODS: From September 2014 and August 2015, we performed a retrospective analysis of 77 patients who underwent orthopedic surgery of the shoulder or the elbow in our hospital. The composition of the intravenous PCA administered to the patients was as follows: 250 mg of dexketoprofen trametamol, 70 mg of oxycodone, and 0.6 mg of ramosetron, which were made up to 79 ml of normal saline. We evaluated and statistically analyzed the difference in the visual analogue scale (VAS) scores for pain at immediate postoperation, at 24 hours of PCA, at 72 hours of PCA, and after discontinuation of PCA and in the incidence of adverse events. RESULTS: We found that VAS score decreased for 3 postoperative days and that with discontinuation of IV PCA a meaningful change in VAS score was no longer seen. Of the 77 patients, 22 presented with adverse events (28.6%). We terminated IV PCA temporarily in the 21 patients who presented with adverse events; we terminated analgesia permanently in one patient (1.2%). Consequently, 76 of 77 patients carried out IV PCA till the designated period. CONCLUSIONS: Intravenous PCA after orthopedic surgery of the shoulder or the elbow may be accompanied with adverse events. Careful assessment of the patient and treatment of the adverse outcomes are key to a successful maintenance of PCA and to a successful management of postoperative pain.
Analgesia ; Analgesia, Patient-Controlled ; Anti-Inflammatory Agents, Non-Steroidal ; Elbow ; Humans ; Incidence ; Orthopedics ; Oxycodone ; Pain Management ; Pain Measurement ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; Shoulder

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.
Humans ; Humerus ; Male ; Neuralgia ; Neuroma ; Organic Chemicals ; Saphenous Vein ; Sural Nerve ; Transplants ; Ulna ; Ulnar Nerve ; Veins

PURPOSE: The aim of this study was to assess the diagnostic accuracy of chest comput-ed radiography for thedetection of bronchiectasis diagnosed by high-resolution CT. MATERIALS AND METHODS: Our study included 100consecutive patients with bronchiec-tasis and 20 normal subjects, all seen on high-resolution CT. Two independentobservers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the invo lved lobe. RESULTS: On high-resolution CT, bronchiectasis was seen in one lobe in 29 patients, two lobes in 29,three lobes in 16, four lobes in 14, five lobes in 10, and six lobes in t wo. The bronchiectasis was tubular in 55patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, andaccuracy of chest com-puted radiography was 95%, 85%, and 93%, respective l y, while for observer 2, thecorresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observ-er 1 were 33% and 96% for theright upper lobe (46% and 95% for observer 2), 68% and 86% for the right middle lobe (76% and 86%), 70% and 78%for the right lower lobe (48% and 83%), 50% and 100% for the left upper lobe (50% and 97%), 63% and 90% for thelingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respective l y. Tubularbronchiectasis involving a single lobe was the most common source of false negative readings based on the findingsof chest com-puted radiography. CONCLUSION: Because chest computed radiography is not inferior to high-resolutionCT for the detection of bronchiectasis, the routine use of chest computed radiography in screening forbronchiectasis is feasible. Howeve r, due to its low sensitivity in detect-ing bronchiectasis in a specific lobe,preoperative high-resolution CT examination may be needed.
Bronchiectasis* ; Humans ; Mass Screening ; Radiography* ; Reading ; Sensitivity and Specificity ; Thorax*

PURPOSE: To identify the causes of failure after unicompartmental knee arthroplasty (UKA), and to evaluate considerations for surgical procedures and the results of revision total knee arthroplasty (TKA) performed after failure of UKA. MATERIALS AND METHODS: Eight hundreds and fifty-two cases of UKA were performed from January 2002 to June 2011. Forty-seven cases of failures after UKA were analyzed for the cause of the failures, and thirty-five cases of revision TKA after failure were analyzed for the operative findings and surgical technique. The clinical results were measured for thirty cases which were followed-up on at least two years after TKA. The mean duration of follow-up was four years and one month after revision TKA and the mean patient age at the time of surgery was sixty-five years. RESULTS: For the cause of failures after UKA, there were twenty-two cases of early loosening of prosthesis, seventeen cases of simple mobile bearing dislocation, five cases of infection, one case of fracture of medial tibial condyle and two cases of unknown origin pain. In operative findings of thirty-five cases of TKA after failed UKA, there were twenty-seven cases of bone defect requiring treatment and the mean thickness of the defect was 10.6 mm. For the treatment of bone defect, there were five cases of autogenous bone graft, twenty-one cases of metal blocks, and one case of autogenous bone graft with metal block. The stem was used in tibial implants for nineteen cases, and one case of use in tibial and femoral implants. For thirty cases where follow-ups were possible at least two years after operation, the mean knee score was improved from 68.2 to 85.2 and the mean knee function score was improved from 67.7 to 78.0 at the last follow-up, respectively. The mean range of knee motion was 107.2degrees pre-operatively, which was recovered to 120.7degrees after the operation. The mean tibiofemoral angle was changed from 1.7degrees of valgus to 5.2degrees of valgus. CONCLUSION: As shown in this study, the tibial bone defect was the most important problem in revision TKA after failure of UKA. Therefore, proper indication and accurate surgical technique using autogenous bone graft, metal block and stemmed implants would be able to achieve satisfactory results in revision TKA after failure of UKA.
Arthroplasty ; Dislocations ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Prostheses and Implants ; Transplants ; Ursidae

PURPOSE: The purpose of this study is to evaluate the accuracy of differentiation between benign and malignant clustered microcalcifications without mass on mammogram. MATERIAL AND METHODS: Fourty six mammogramsof 44 patients showing clustered microcalcifications without mass were interpreted blindly by five independent observers majoring in breast imaging from different institutions. Twenty two were malignant (10 infiltratingductal carcinomas, 12 intraductal carcinomas) and 24 were benign (all fibrocystic disease). The observers judgebenignancy or malignancy of microcalcifications. The authors assess the accuracy of differential diagnosis of clustered microcalcifications. RESULT: Of 24 cases proved benign microcalcifications, five radiologists correctly interpreted 20 on average as benign and of malignant 22 cases, 16 on average were correctly interpreted asmalignant. The diagnostic accuracy of malignant microcalcifications was 71.8% on average(63.6%-81.8%) and the diagnostic accuracy for benign microcalcifications was 83% on average(71% - 92%). It was 9 among total 46 cases that were misinterpreted by more than three radiologists. Among these 9 cases, malignant microcalcifications thathad been misinterpreted as benign were seven, benign microcalcifications misinterpreted as malignant were two. CONCLUSION: The diagnostic accuracy of clustered malignant microcalcifications(71.8%) without mass on mammogramwas lower than that of benign microcalcifications(83.3%). So, in case of suspected malignant microcalcification onmammogram, it is preferable that along with magnification view, histopathologic confirmation by core biopsy mustbe obtained.
Biopsy ; Breast ; Diagnosis, Differential ; Humans ; Mammography*