BACKGROUND: The purpose of this study was to make a comparative analysis of the clinical outcomes after the operative treatment of refractory medial epicondylitis between the suture anchor group and the non-suture anchor group. METHODS: We enrolled 20 patients (7 men and 13 women) with recalcitrant medial epicondylitis who were able to receive operative treatment in a minimum of an 18-month follow-up. The mean age was 48.6 years (range, 36-59 years). The patients were allocated into either the suture anchor group (7 patients) or the non-suture anchor group (13 patients). We evaluated clinical outcomes using the visual analog scale (VAS), the pain grading system of Nirschl and Pettrone, and postoperative grip strength. RESULTS: The VAS score decreased from 8.8 to 2.0 for the suture anchor group and from 8.6 to 1.3 for the non-suture anchor group (p=0.16). The postoperative grip strength was 95%, 93% of the non-treated arm in both groups (p=0.32). The postoperative satisfaction level was good in 5 patients and fair in 2 for the suture anchor group and excellent in 5 patients, good, in 4, and fair, in 4 for the nonsuture anchor group (p=0.43). The clinical outcomes did not show a statistically significant difference between the two groups. CONCLUSIONS: We found that patients with recalcitrant medial epicondylitis were treated reliably with satisfactory clinical outcomes whether or not suture anchors were used. We believe the use of suture anchors when more than 50% of the tendon origin is affected provides an effective and favorable treatment modality.
Arm ; Elbow ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Suture Anchors* ; Sutures* ; Tendons ; Visual Analog Scale

Hip arthrograghy is a valuable procedure for visualization of the intrinsic obstructive factors impeding closed reduction and for critical assessment of quality of reduction in developmental dislocation of the hip. The authors have analyzed 25 cases of developmentally dislocated hips in 24 patients who have been followed up for more than 1 year postoperatively by roentgenographies and arthrographies. Among them 16 cases in 16 patients who had been treated by closed reduction according to acceptable quality of initial reduction were studied to estimate a value of arthrography and to evaluate an outcome of closed rediction performed on the base of an arthrographic finding. The following results were obtained. 1. The frequency of the common arthrographic observations were assessed. Medial dye columns identifying the depth of reduction were observed 25 cases(100%), configuration of osteocartilaginous structures in 24 cases(96.0%), limbus in 24 cases(96.0%), and ligamentum teres in 18cases(75.0%). 2. Good closed reduction classified according to Race and Herring on initial arthrography was associated with rapid improvement of acetabular angle and the CE angle and low incidence of avascular necrosis, compared with adequate or poor reduction. 3. In cases of initial good and adequate reductions, initial AP arthrograms showed some dye filling shadows owing to folding or redundancy of lax joint capsule of the dislocated hip after reduction just lateral to the limbus, of which finding decreased markedly on the second arthrograms. 4. The widths of medial dye column decreased with time during the first postoperative 7 weeks by an average of 0.5mm in cases with initial good quality of reduction, 3.5mm in adequate reductions and 0.5mm in poor reductions. 5. In cases with adequate closed reduction on initial arthrogram, but without substantial decrease in width of medial dye column on the second arthogram the outcome was poor. In those cases with decrease in width of medial dye column on the second arthrogram compared with initial arthogram, the shorter the period of immobilization in a plaster cast was, the worse eventual result was. 6. We think that hip arthography is a helpful procedure for visualization of obstacle obstructing closed reduction and for determination of treatment modality in developmental dislocation of the hip.
Acetabulum ; Arthrography ; Casts, Surgical ; Continental Population Groups ; Dislocations ; Hip ; Humans ; Immobilization ; Incidence ; Joint Capsule ; Necrosis ; Round Ligaments

No abstract available.
Giant Cell Tumors* ; Giant Cells* ; Knee Joint* ; Knee*

No abstract available.
Female ; Lactation*

The rectal prolapse syndome is a disease entity includes rectocele and rectal prolapse, presenting prolapse(procidentia) of rectum. In rectocele, rectum is prolapsed anteriorly into the vagina, whereas in procidentia, inferiorly out of the anus. This study was aimed at analyzing pathogenesis and adequacy of surgical treatment in rectocele and rectal prolapse. Twenty-one patients with rectocele and 18 patients with rectal prolapse were assessed pre- and post-operatively in respect to symptoms and signs, pathogenesis, defecography, and manometry. In analysis of symptoms and sings, constipation was the commonest in both diseases(86% of rectocele and 67% of rectal prolapse) and incontinence was not infrequently found in both diseases as well(14% of rectocele and 33% of rectal prolapse). In analysis of the underlying causes, two patients with rectal prolapse had prolapse from childhood. Defecography showed anorectal angle of rectal prolapse in rest and push period. They were significantly wider than those of rectocele(p<0.05). The perineal descent of rectal prolapse was longer than that of rectocele. In analysis of the associated factors, average number of delivery was more than three times in both diseases(3.5 of rectocele and 5.1 of rectal prolapse). We could easily find previous operation history in both diseases. Among them, hysterectomy was the most frequent, especially in patients with rectocele. The hemorrhoids was associated more common in rectocele than in rectal prolapse(p<0.05). Preoperative maximal resting pressure of rectal prolapse was more significantly decreased than that of rectocele(p<0.05). The sensation of fullness was significantly decreased in patients with rectal prolapse postoperatively(p<0.05). Patients with rectocele underwent levator plication by transrectal or vaginal approach. Patients with rectal prolapse underwent posterior rectopexy in 11 patients, resection and rectopexy in 3 patients, Delorme's operation and Thiersch operation in 2 patients each. Constipation was significantly improved in patients with rectocele postoperatively(p<0.05). Incontinence was markedly improved in patients with rectal prolapse postoperatively(p<0.05). At the interview about subjective improvement of symptom, 95% of patients with rectocele and 89% of patients with rectal prolapse were satisfied with surgery. In conclusion, rectocele and rectal prolapse can be categorized as rectal prolapse syndrome because both diseases have anatomical derangements caused by similar pathogenesis such as altered bowel habits, anatomical factor, delivery, past history of hysterectomy, and hemorrhoids. Levator plication and posterior rectopexy seem to be useful surgical methods of anatomical repair for the respective disease.
Anal Canal ; Constipation ; Defecography ; Hemorrhoids ; Humans ; Hysterectomy ; Manometry ; Prolapse ; Rectal Prolapse* ; Rectocele ; Rectum ; Sensation ; Vagina

No abstract available.
Carcinoma, Small Cell* ; Female ; Ovary*

PURPOSE: To analyze the final results of a two-stage flexor tendon reconstruction in the hand with the early postoperative combined protocol of controlled motion, and to identify the prognostic factors associated with the final results. MATERIALS AND METHODS: Nine cases of two-stage flexor tendon reconstructions in 9 patients, who had been unable to flex their digits due to old flexor tendon injury, were examined. Using the modified Boyes' injury severity classification, the digits were classified as grades 1, 2 and 3 in 1, 5 and 3 patients, respectively. The average follow-up period was 1 year and 8 months and the final results are expressed using the Buck-Gramcko assessment system. RESULTS: Eight out of nine hands were graded as excellent and one patient whose injury severity had been graded 3 was graded as good. Excellent results were found in patients with a more than 10-year interval between the injury and the stage I procedure. Of the 3 patients who had undergone contracture release two were excellent and one was good. All 5 patients with a pulley reconstruction had excellent results. Complications involved one infection at the distal incision site, one tendon rupture and four flexion contractures. CONCLUSION: A two-stage flexor tendon reconstruction with an early postoperative combined protocol of controlled motion is a useful procedure for restoring the flexor performance in old badly scarred digits. The excellent or good results might be due to following: the early protected rehabilitation incorporating two protocols, a pulley reconstruction and protection, flexion contracture release, an initial injury with less than moderate grade and the young age of the patients.
Cicatrix ; Classification ; Contracture ; Follow-Up Studies ; Hand* ; Humans ; Rehabilitation ; Rupture ; Tendon Injuries ; Tendons*

A 54-year-old male patient who was suffering from bipolar I disorder for 19 years and was admitted to the National Bugok Mental Hospital due to a depressive episode, was referred to the Kosin University Gospel Hospital. On arrival at the emergency room, he had confused mentality with disorientation, memory impairment, hypomania, marked anxiety and hyperirritability. The change of neuromuscular activity such as ataxia, gait disturbance, tremor, shivering, myoclonus and epileptic seizures was also shown. In addition, the symptoms and signs of autonomic instability including diaphoresis, tachycardia, hypotension, fever and facial flushing were noticed. The above symptoms developed after the administration of sertraline successive to the discontinuation of fluoxetine without any washout period. The degree of severity seemed to be severe because he had epileptic seizures, fever and hypotension. He was recovered from the severe serotonin syndrome by the supportive symptomatic treatment with sodium valproate, clonazepam, lorazepam and cyproheptadine after cessation of the selective serotonin reuptake inhibitors during hospitalization. Therefore, this rare case of severe serotonin syndrome was reported and related literatures were also reviewed.
Anxiety ; Clonazepam ; Cyproheptadine ; Emergency Service, Hospital ; Epilepsy ; Fever ; Fluoxetine* ; Flushing ; Gait Ataxia ; Hospitalization ; Hospitals, Psychiatric ; Humans ; Hypotension ; Lorazepam ; Male ; Memory ; Middle Aged ; Myoclonus ; Serotonin Syndrome* ; Serotonin Uptake Inhibitors ; Serotonin* ; Sertraline* ; Shivering ; Tachycardia ; Tremor ; Valproic Acid

PURPOSE: To evaluate the usefulness of whole body bone mineral densitometry in the diagnosis of frequent osteopenia of preterm infants by comparison with the wrist radiographs and biochemical parameters. MATERIALS AND METHODS: From January 1995 to January 1996, we obtained whole body bone mineral density(BMD) studies using dual energy X-ray absorptiometry(DXA) and wrist radiographs of 39 preterm infants. They were divided into three groups according to birth weight, under 1500g, 1501g to 2000g and above 2000g, and four grades of skeletal change, as seen on wrist radiography, according to the scoring method of Koo et al. Groups of birth weight and grades of skeletal change were then correlated with whole body BMD and biochemical parameters. For comparison, normal data were obtained from 13 infants born at full term. Data were analyzed by one way analysis of variation(ANOVA) and correlation and regression analysis. A p-value of less than 0.05 was considered significant. RESUTLS: Whole body BMDs were significantly lower in the more premature and smaller birth weight infants(r=0.77, p=0.0000), and in the higher grade of skeletal change (r=-0.5276, p=0.0000). Aggravated skeletal changes were found in infants with lower birth weight(r=-0.3822, p=0.01). Interobserver variation in grading skeletal change was 42.9%, and intraobserver variation was 18.4%. Biochemical parameters such as serum calcium, phosphate, alkaline phosphatase, parathromone, calcitonin and 25-hydroxy-vitamine D did not vary significantly according to either birth weight or skeletal change (p>0.05). CONCLUSION: Premature osteopenia is more effectively diagnosed by measuring whole body BMD using DXA than by grading radiographical skeletal change or by biochemical parameters.
Alkaline Phosphatase ; Birth Weight ; Bone Diseases, Metabolic* ; Calcitonin ; Calcium ; Densitometry* ; Diagnosis ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Observer Variation ; Parturition ; Radiography* ; Research Design ; Rickets ; Wrist*

AIMTo evaluate the effects of 60 Hz extremely low frequency (ELF) elelctromagnetic field (EMF) exposure on germ cell apoptosis in the testis of mice.

METHODSAdult male BALB/c mice (7 weeks of age) were exposed to a 60 Hz EMF of 0.1 mT or 0.5 mT for 24 h/day. A sham-exposed group served as the control. After 8 weeks of exposure, the mice were sacrificed. Germ cell apoptosis in the testis was assessed by histopathological examination, the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL) and flow cytometric examination of isolated spermatogenic cells stained with 7 aminoactinomycin D (7-AAD).

RESULTSEMF exposure did not significantly affect the body and testis weights, but significantly increased the incidence of germ cell death. The distinguishing morphological feature of EMF exposure was a decrement in the number of well organized seminiferous tubules. Quantitative analysis of TUNEL-positive germ cells showed a significantly higher apoptotic rate in the 0.5 mT exposed mice than that in the sham controls (P<0.05), while the difference between the two exposed groups was insignificant. The TUNEL-positive cells were mainly spermatogonia. In flow cytometry analysis, the percentage of live cells [forward scatter count (FSC)(high)7-AAD(-)] was lower in the exposed groups than that in the controls (Figure 5A), but the decrease in viability was not statistically significant.

CONCLUSIONContinuous exposure to ELF EMF may induce testicular germ cell apoptosis in mice.

Animals ; Apoptosis ; Body Weight ; Electromagnetic Fields ; adverse effects ; Flow Cytometry ; In Situ Nick-End Labeling ; Male ; Mice ; Mice, Inbred BALB C ; Organ Size ; Spermatozoa ; cytology ; Testis ; cytology