Total hip arthroplasty (THA) can be a good treatment option for avascular necrosis (AVN) of the femoral head. However, because dislocation can frequently occur after surgery, THA is a concern in patients with a neuromuscular disease, such as cerebral palsy or poliomyelitis. In patients with poliomyelitis, only one case of AVN of the femoral head in the affected limb has been reported in the English literature. Here, the authors report on a case of AVN of the femoral head in a patient with poliomyelitis, who was treated with a large diameter femoral head metal-on-metal THA using a modified minimally invasive-2-incision technique.
Arthroplasty ; Cerebral Palsy ; Dislocations ; Extremities ; Head ; Hip ; Humans ; Necrosis ; Neuromuscular Diseases ; Poliomyelitis ; Tacrine

Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

Because information on biological agents in the workplace is lacking, biological hazard analyses at the workplace to securely recognize the harmful factors with biological basis are desperately needed. This review concentrates on literatures published after 2010 that attempted to detect biological hazards to humans, especially workers, and the efforts to protect them against these factors. It is important to improve the current understanding of the health hazards caused by biological factors at the workplace. In addition, this review briefly describes these factors and provides some examples of their adverse health effects. It also reviews risk assessments, protection with personal protective equipment, prevention with training of workers, regulations, as well as vaccinations.
Biological Factors ; Humans ; Risk Assessment ; Social Control, Formal ; Vaccination

Since the concept of osseointegration has been introduced, a lot of researches were performed to achieve stronger fixation of the implant. In this study, we tried to find the different pattern of bone ingrowth after implanting pure titanium implant and Hydroxyapatite coated titanium implant in dogs. Four typed of cylindrical titanium implants (diameter 6 mm, length 1 mm) were inserted in the distal femur of adult dogs. The histological examination was done at postoperative 2, 4, 8, and 12 weeks. There was no foreign body reaction at contact site and all implants kept direct contact with bone tissue. In the light microscopic finding, after 2 weeks, the cases with Hydroxyapatite-coated Implant (HAP) showed greater formation of immature woven bone in comparison to Titanium implant. After 4 weeks, Hydroxyapatite-coated Implant (HAP) showed more mature lamellar bone. After 8 and 12 weeks, most of the woven bone was transformed into mature lamellar bone. The fluorescence microscopic finding, after 2 weeks, revealed calcein green fluorescence around implants in all cases and it was more prominent in the cases with Hydroxyapatite-coated Implant (HAP). After 4 weeks, the center of trabecula gave out green fluorescent light, the corner of them showed red fluorescent light, and they were more prominent in the cases with Hydroxyapatite-coated Implant (HAP). After 8 and 12 weeks, green fluorescence disappeared gradually, red fluorescence appeared for the most part, and there was no difference in each cases, especially in 12 weeks. As a result, we support the concept that Hydroxyapatite-coated Implant (HAP) induces faster bone ingrowth in 4 weeks than Titanium implant, and that it may be more profitable for early bone ingrowth and implant stability.
Adult ; Animals ; Bone and Bones ; Dogs* ; Durapatite ; Femur ; Fluorescence ; Foreign-Body Reaction ; Humans ; Osseointegration ; Titanium*

An amelanotic malignant melanoma is characterized by little or no pigment. It is frequently misdiagnosed because it is a rare entity in general, and because of its unusual clinical features. Liposarcoma is one of the most common adult soft tissue sarcomas. We encountered a case of amelanotic melanoma with a concurrent liposarcoma. A 68-year-old man presented with a single, 1.5x1.5 cm round erythematous, eroded nodule on the left heel. A biopsy specimen showed atypical, pleomorphic tumor cells with little melanin pigment. The tumor cells were positive for S-100, HMB-45 and negative for cytokeratins. These findings were consistent with amelanotic melanoma. On positron emission tomography/computed tomography (PET/CT), a hypermetabolic lesion was found in the left buttock. This lesion was excised and diagnosed as a well-differentiated liposarcoma. An association between sarcomas and other primary malignancies has been reported. However, an association between melanoma and liposarcoma is rare.
Adult ; Aged ; Biopsy ; Buttocks ; Cytochrome P-450 CYP1A1 ; Electrons ; Heel ; Humans ; Keratins ; Liposarcoma ; Melanins ; Melanoma ; Melanoma, Amelanotic ; Sarcoma

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. (continue)
Cervix Uteri* ; Conization ; Delivery of Health Care ; Diagnosis* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies

Staphylococcus aureus induces chronic infection in form of biofilm that exists in the host cells and arthroplastic prosthesis surface. In this study, the biofilm formation ability of S. aureus clinically isolated from bacteremia patients, biofilm processing and relationship of resistance to antibiotics, and difference of biofilm formation ability on different prosthetic material surfaces were studied. All of them formed biofilm and especially 6 strains of S. aureus had high ability of biofilm formation. In addition, it was found that some strains with higher biofilm formation ability make more higher polysaccharide layer production. When S. aureus ATCC 25923 forms biofilm, minimal bactericidal concentration (MBC) of biofilm bacteria is more increased than that of the planktonic state bacteria about one thousand folds. Especially, after 6 hours from starting on biofilm formation, the resistance to antibiotics was increased by more than 256 microgram/ml of MBC to every antibiotics and after 8 hours prominent increase (more than 4096 microgram/ml) was noted. Biofilm formation after bacterial adherence to plastic cover-slip was increased with time-dependent manner. Microcolonies were formed after 5 hours from a point that bacteria adhere to plastic cover-slip surface and after 6 hours biofilm was diffusely formed on entire surface, and then after 8 hours very thick biofilm was formed. Thicker biofilm was found on cobalt-chromium than titanium surface. These results suggest that titanium alloy materials are better than cobalt-chromium to minimize S. aureus biofilm formation on the arthroplastic material surface. Also, when microcolonies are formed after adherence of S. aureus to the arthroplastic material surface, resistance to antibiotics is starting.
Alloys ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Biofilms ; Humans ; Plankton ; Plastics ; Prostheses and Implants ; Staphylococcus ; Staphylococcus aureus ; Titanium

PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF). MATERIALS AND METHODS: Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared. RESULTS: The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3degrees (105degrees-140degrees) in the DCP group and 118.4degrees (110degrees-140degrees) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups. CONCLUSION: A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Femoral Fractures ; Follow-Up Studies ; Hip ; Humans ; Knee ; Knee Joint ; Periprosthetic Fractures* ; Range of Motion, Articular ; Walking

We present successful resuscitation in a mentally disabled young male who has isolated jejunal perforation without trauma history. Abdominal computed tomography scan showed large amount of free intraperitoneal air. Cardiac arrest occurred after anesthetic induction. Following resuscitation, emergent exploratory laparotomy revealed only a 3-cm perforation of the jejunum, 40 cm from the ligament of Treitz. During operation, repeated cardiac arrest occurred. Fortunately, the operation was successfully completed and patient discharged 15th day after operation without complications.
Heart Arrest ; Humans ; Intellectual Disability ; Jejunum ; Laparotomy* ; Ligaments ; Male ; Mentally Disabled Persons* ; Resuscitation* ; Shock, Septic

PURPOSE: To compare the postoperative complications and cost-effectiveness of simultaneous and staged bilateral total hip arthroplasty (THA), using a minimally invasive two-incision technique. MATERIALS AND METHODS: All 206 patients who underwent simultaneous or staged bilateral THA using a modified, minimally invasive two-incision between January 2004 and November 2009 were registered and divided into a simultaneous bilateral THA group (group A, 147 patients) and staged bilateral THA group (group B: 59 patients). Staged THA was performed on group B with interval of at least 2 months between the initial and second surgery. Clinical evaluations, amount of blood loss, need for transfusion, complications and costeffectiveness were compared. RESULTS: Perioperative morbidity rates were similar in the two groups (P=0.546) and overall complications were not significant between the groups. Average length of hospital stay was significantly shorter in group A than in group B (average 14.6 days vs. 25.3 days; P<0.001). Total medical cost was significantly higher in group B than in group A (average 9,236 US dollars vs. 11,163 US dollars). Patients in group A required more blood transfusions than those in group B (3.02 vs. 1.90 units; P=0.003), although blood loss in the two groups were similar (892 vs. 917 ml P=0.613). CONCLUSION: Comparison of intra- and postoperative complications support the conclusion that simultaneous bilateral THA compares favorably with staged THA in terms of outcomes, complications and cost-effectiveness.
Arthroplasty, Replacement, Hip* ; Blood Transfusion ; Humans ; Length of Stay ; Methods ; Postoperative Complications*