No abstract available.
Arthrodesis* ; Femur* ; Giant Cell Tumors* ; Giant Cells* ; Transplants*

PURPOSE: The goals of cranioplasty are to protect the brain from trauma and restore normal cranial contour with as few complication as possible. In patient who suffered from cranial defect, the most satisfactory form of cranioplasty may be archived with autogenous bone grafts. We report on the treatment of large frontal bone defect using pericranial flap and split-rib graft. METHODS: A 29-year-old male was referred to our department. He was involved in an automobile accident resulting in large frontal bone and sinus defect and skull basal defect. The reconstruction was undertaken using galeal frontalis myofascial flap and split-rib cranioplasty using bicoronal incision. RESULTS: The postoperative course was successful. For 9 months follow up period, there was no complication about hematoma, infection, CSF leakage and washboard deformity. He was pleased with the results even when absolute symmetry was not achieved. CONCLUSION: We experienced large frontal bone and sinus defect and skull basal defect patient and successfully treated with split-rib graft and galeal frontalis myofascial flap.
Adult ; Automobiles ; Brain ; Congenital Abnormalities ; Follow-Up Studies ; Frontal Bone ; Hematoma ; Humans ; Male ; Skull ; Transplants

PURPOSE: This study was conducted to investigate the incidence, associated factors and clinical impact of hyperamylasemia in self-poisoning patients. METHODS: This study was based on a toxicology case registry of patients treated from 2009 to 2013 at a tertiary care university hospital. We retrospectively investigated the demographics, clinical variables, laboratory variables and intoxicants. Hyperamylasemia was defined as an elevation in serum amylase level to above the upper normal limit within 24 hours after admission. We analyzed the predisposing factors and clinical outcomes of patients in the hyperamylasemia group. RESULTS: Hyperamylasemia was identified in 49 (13.3%) of the 369 patients. Using multivariate logistic regression, the odds ratios for HA were 3.384 (95% confidence interval, 1.142-8.013, p=0.014), 3.261 (95% confidence interval, 1.163-9.143, p=0.025) and 0.351 (95% confidence interval, 0.154-0.802, p=0.013) for pesticides, multi-drug use and sedatives, respectively. In the hyperamylasemia group, the peak amylase levels during 72 hours were correlated with the peak lipase levels (r=0.469, p=0.002) and peak aspartate aminotransferase levels (r=0.352, p=0.013). Finally, none of these patients had confirmed acute pancreatitis. CONCLUSION: Hyperamylasemia occurred rarely in these self-poisoning patients, and pesticide and multi-drug use were independent predictors of hyperamylasemia. Peak amylase levels were correlated with the peak lipase and aspartate aminotransferase levels.
Amylases ; Aspartate Aminotransferases ; Causality ; Demography ; Humans ; Hyperamylasemia* ; Hypnotics and Sedatives ; Incidence* ; Lipase ; Logistic Models ; Odds Ratio ; Pancreas ; Pancreatitis ; Pesticides ; Poisoning ; Retrospective Studies ; Tertiary Healthcare ; Toxicology

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm3 (32,400–203,904/mm3 ), and polymorphic leukocytes were 91.1%±2.6% (86%–95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6–10 hours), and the irrigation period was 8.2±3.2 days (4–15 days). The average length of hospitalization was 20.8±8.7 days (9–37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

OBJECTIVE: To evaluate the maternal and fetal outcomes after transvaginal selective fetal reduction(SFR) in multifetal pregnancy. MATERIALS AND METHODS: Transvaginal SFR using fetal intracardiac puncture with KCl injection and aspiration of amniotic fluid was performed in 58 multifetal pregnancies achieved after assisted reproductive technology(ART). After transvaginal SFR, 55 twin and 3 singleton pregnancies were evaluated and analyzed retrospectively with the medical records of mothers and babies. RESULTS: Of 58 cases, abortion within 4 weeks after SFR occurred in 1 case(1.7%). Miscarriage of all fetuses occurred in 8 cases(13.8%) from 4 weeks after SFR until 24 weeks of gestation. Perinatal death occurred in 8 newborns from 5 mothers due to extreme prematurity in 7 cases and anencephaly in 1 case. Take-home baby rate, that is, discharge with at least 1 healthy baby, was 77.6%(45/58). CONCLUSION: Transvaginal SFR is an acceptable and effective management option in the cases of excessive multifetal pregnancy after infertility treatment. The ultimate successful outcomes of reduced multifetal pregnancy may be enhanced by more extensive experience with SFR.
Abortion, Spontaneous ; Amniotic Fluid ; Anencephaly ; Female ; Fetus ; Humans ; Infant, Newborn ; Infertility ; Medical Records ; Mothers ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Punctures ; Retrospective Studies

OBJECTIVES: It is widely accepted that estrogen has favorable effects on cardiovascular diseases, especially in the postmenopausal women. Endothelin-1(ET-I), released from the vascular endothelium, is a 21-amino acid peptide with strong vasoconstrictor activity. However, the effect of estrogen on the vasoconstriction to ET-1 has not been extensively studied. METHODS: To investigate the effect of estrogen (175beta-estradiol) on the vascular contraction to ET-1, porcine coronary artery(PCA) rings were suspended in organ chambers(37 degrees C, 95% O2/5% CO2) for measurement of isometric tension change. Endothelium was removed mechanically if necessary. In acute experiments, vascular rings were preincubated for 15minutes with 3different concentrations of 170beta-estradiol(10(-6), 10(-5), 10(-4)M) and concentration-contraction curves to cumulative doses of ET-1 were constructed. In the experiments after a longer exposure to 17beta-estradiol, the vessels with endothelium were exposed in the 5% CO2 incubator to 3different concentrations of 17beta-estradiol(10(-9), 10(-8), 10(-7)M) for 44-50 hours, and then concentrationcontraction curves to ET-1 were obtained. RESULTS: Incubation for 15minutes with 170beta-estradiol(10(-4)M) inhibited ET-1-induced contraction in the vessels with endothelium(area under the curve and maximal contraction, p<0.05 compared with control). This effect persisted regardless of the sex and the presence or absence of the endotheliurn. Incubation of the vessels far a longer time with 170beta-estradiol(44-50 hours) resulted in the inhibition of maximal contraction to ET-1(p<0.05) by a lower concentration of 175beta-estradiol(10(-7)M) than in acute experiments in male PCA rings, but an enhanced contraction to ET-1(area under the curve; p<0.05) by 10M of 175beta-estradiol was observed in female PCA rings. CONCLUSION: Short-time incubation with 17Pbeta-estradiol has an inhibitory effect on the contraction to ET-1 in PCA rings. This effect is independent of the presence of the endothelium and the sex of the pigs. A longer incubation with 17beta-estradiol results in a similar inhibitory effect on male(but not female) PCA rings, suggesting that a sex-related difference may exist concerning the effect of 17beta-estradiol on ET-1-induced contraction.
Cardiovascular Diseases ; Coronary Vessels* ; Endothelin-1* ; Endothelins ; Endothelium ; Endothelium, Vascular ; Estrogens ; Female ; Humans ; Incubators ; Male ; Passive Cutaneous Anaphylaxis ; Swine ; Vasoconstriction

OBJECTIVE: To investigate the clinical significance of endometrial thickness and pattan as a predictor of successful implantation of embryos in ovum donation and cryopreserved-thawed embryo transfer program. METHODS: From January, 1996 to March, 1998, 31 cycles of ovum donation and 31 cycles of cryopreserved-thawed embryo transfer were enrolled in this prospective study. Endometrial thickness was measured three times: prior to progesterone administration (P), 1 day and 3 days after P. In cryopreserved-thawed embryo transfer cycles, the measurement at 1 day after P was omitted. Endometrial pattern was observed prior to progesterone, and was considered meaningful when a multi-layered triple-line was seen with prominent outer and central hyperchogenic lines and inner hypoechogenic regions. RESULTS: There were no differences in embryo quality, dose or duration of estrogen, and endometrial thickness or pattern between conception and non-conception cycles in both ovum donation and cryapreserved-thawed embryo transfer pmgram. In ovum donation cycles, no cortelation was observed between estrogen dose and endometrial thickness or pattern. In cryopreserved-thawed embryo transfer cycles, total estrogen dose and endometral thickness at 3 days after P has a inverse correlation, and estrogen dose over 4.3 mg per day can predict expression of a multi-layered triple-line pattern, CONCLUSION: Endometrial thickness or pattern. cannot predict a successful implantaion of embryos in both ovum donation and cryopreserved-thawed embryo transfer cycles.
Embryo Transfer* ; Embryonic Structures* ; Estrogens ; Fertilization ; Oocyte Donation* ; Ovum* ; Progesterone ; Prospective Studies

PURPOSE: In the past, laymen or beauty parlor employees commonly injected people with unproven foreign material such as paraffin, silicone, and cooking oil. We have treated a patient who injected foreign material into her face and neck. METHODS: For the last 20 years, a 43-year-old woman has been injecting herself in the face and neck with foreign material. There was no tenderness, erythema, pain, ulceration, or necrosis. However many visible, touchable subcutaneous masses were found. Her face was extremely ugly and disfigured by the foreign material. We could not recognize the boundary between her neck and mandible. The occipital scalp drooped extremely. Over the past 3 years, from February 2005 to October 2007, we performed 15 operations. RESULTS: We conducted a cephalometric facial analysis to compare preoperative and postoperative facial diameter. The patient's upper face diameter decreased from 67cm to 60 cm, the mid face diameter from 82cm to 59cm, the lower face diameter from 63 cm to 50cm, and the neck circumference diameter from 53cm to 44cm, respectively. The mid sagittal diameter decreased from 26 cm to 23cm. The total excised tissue weight was 4023.7 gram after 15 operations. CONCLUSION: Serial excision of face and neck masses in a patient who injected herself with foreign material resulted in a satisfactory outcome.
Adult ; Beauty ; Cooking ; Erythema ; Female ; Foreign Bodies ; Humans ; Mandible ; Neck ; Necrosis ; Paraffin ; Scalp ; Silicones ; Ulcer

Suicidal strangulation by ligature (so-called self-strangulation) is distinctly uncommon. It is distinct from self-suspension in cases of hanging, the latter being a far more common form of suicide. Suicidal strangulation by ligature must be separated from homicidal strangulation by ligature. But clear distinction between the homicidal and suicidal strangulation by ligature is often impossible on the basis of the anatomical findings alone, although fractures of the larynx in suicidal strangulations are distinctly unusual. An accurate evaluation of circumstances, a thorough post-mortem examination, and inspection of the scene are extremely important in such cases. It is equally important to examine the type of noose and knot as well as the number of turns around the neck. We reports three cases of suicidal strangulation by ligature with brief review of literature.
Asphyxia ; Autopsy ; Larynx ; Ligation* ; Neck ; Suicide

One case of the iatrogenic injury of carotid artery is reported. The deceased person was a 54-yearold woman. She visited a local clinic because she had the severe pain on back and neck and the radiating pain of left lower extremity. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. Cardiopulmonary resuscitation was performed, however eventually she died. The autopsy was performed. In the neck, large hematoma at the posterior portion of neck organ and perforation of right carotid artery were noted.
Autopsy* ; Cardiopulmonary Resuscitation ; Carotid Arteries* ; Cyanosis ; Diagnosis ; Female ; Hematoma ; Humans ; Lower Extremity ; Neck ; Syncope