PURPOSE: To evaluate the clinical characteristics of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures and assess the surgical outcomes of a novel, closed intramedullary nailing surgical approach designed to minimize fixation failure. MATERIALS AND METHODS: Between May 2013 and April 2017, 31 patients with intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing or long proximal femoral nail antirotation (PFNA) were enrolled in this study. Preoperative data included age, sex, injury severity score, body mass index, location of shaft fracture, injury mechanism, accompanying traumatic injury, walking ability before injury, and surgical timing. Perioperative outcomes, including follow-up period, types of intramedullary nails, number of blocking screws used, operation time, and blood loss were assessed. Radiologic outcomes, including union rate, time from surgery to union, and femoral shortening, and clinical outcomes, including hip flexion, walking ability, and Harris hip score were also evaluated. RESULTS: A total of 29 unions (93.5%) were achieved. The time to union was 16.8 months (range, 11–25 months) for hip fractures (15.7 weeks for intertrochanteric fractures and 21.7 weeks for subtrochanteric fractures) and 22.8 months for femoral shaft fractures. There were no significant differences in surgical outcomes between the two groups except for type of intramedullary nail. CONCLUSION: Closed intramedullary nailing in the treatment of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures may be a good surgical option. However, fixation of femoral shaft fractures might not be sufficient depending on the implant design.
Body Mass Index ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Hip Fractures ; Humans ; Injury Severity Score ; Walking

No abstract available.
Animals ; Epithelium* ; Gene Expression* ; Laser Capture Microdissection* ; Mice* ; Microarray Analysis* ; Phenobarbital*

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.
Child, Preschool ; Cost Sharing/*legislation & jurisprudence ; *Health Policy ; Health Services/*utilization ; Hospitalization ; Humans ; Insurance Claim Review ; Korea ; Length of Stay

OBJECTIVE: This study aims at investigating the incidence, clinical nature and associated clinical characteristics of the clozapine-induced fever. METHODS: Retrospective review of hospital records was performed for 56 inpatients who had started to take clozapine and stayed at the hospital for four or more weeks after the initiation of clozapine treatment. RESULTS AND CONCLUSION: Clozapine-induced fever was developed in 31% of the patients. The mean peak temperature was 39degrees C and the mean duration of the fever was 3 days. Fever was developed average of 11 days after the initiation of clozapine treatment. All the patients were recovered without discontinuation of clozapine. Demographic variables, the clinical response to clozapine, other drugs administered with clozapine, and the presence of other adverse effects of clozapine were not associated with the clozapine-induced fever.
Clozapine* ; Fever* ; Hospital Records ; Humans ; Incidence* ; Inpatients ; Retrospective Studies ; Schizophrenia

A hyalinizing trabecular adenoma (HTA) is a rare benign thyroid tumor of follicular epithelial cell origin with a trabecular-alveolar growth pattern and marked intratrabecular hyalinization. The cytological and histological features of HTA are very similar to those of papillary and medullary carcinomas of the thyroid. Therefore, an accurate diagnosis of HTA is important to avoid unnecessary and potentially harmful management of patients. However, the results of BRAF gene mutation analysis shown by many studies are distinctly different between HTAs and papillary thyroid carcinomas. Herein, we describe a rare case of HTA of the thyroid in a 49-year-old female and consider its characteristic cytological features and BRAF gene mutation analysis results with a brief review of the literature.
Adenoma ; Carcinoma, Medullary ; Epithelial Cells ; Female ; Humans ; Hyalin ; Middle Aged ; Thyroid Gland ; Thyroid Neoplasms

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.
Adolescent ; Cytoplasm ; Eosinophils ; Ependymoma ; Female ; Frozen Sections ; Giant Cells ; Humans ; Intranuclear Inclusion Bodies ; Mitosis ; Necrosis

No abstract available.
Antibodies, Monoclonal* ; Borrelia burgdorferi* ; Borrelia* ; Lyme Disease*

BACKGROUND: This study was conducted to investigate the roles of the spinal and peripheral gamma-aminobutyric acid (GABA)-ergic systems for the mechanical hypersensitivity produced by chronic compression of the dorsal root ganglion (CCD). METHODS: CCD was performed at the left 5th lumbar dorsal root ganglion. The paw withdrawal threshold (PWT) to von Frey stimuli was measured. The mechanical responsiveness of the lumbar dorsal horn neurons was examined. GABAergic drugs were delivered with intrathecal (i.t.) or intraplantar (i.pl.) injection or by topical application onto the spinal cord. RESULTS: CCD produced mechanical hypersensitivity, which was evidenced by the decrease of the PWT, and it lasting for 10 weeks. For the rats showing mechanical hypersensitivity, the mechanical responsiveness of the lumbar dorsal horn neurons was enhanced. A similar increase was observed with the normal lumbar dorsal horn neurons when the GABA-A receptor antagonist bicuculline was topically applied. An i.t. injection of GABA-A or GABA-B receptor agonist, muscimol or baclofen, alleviated the CCD-induced hypersensitivity. Topical application of same drugs attenuated the CCD-induced enhanced mechanical responsiveness of the lumbar dorsal horn neurons. CCD-induced hypersensitivity was also improved by low-dose muscimol applied (i.pl.) into the affected hind paw, whereas no effects could be observed with high-dose muscimol or baclofen. CONCLUSIONS: The results suggest that the neuropathic pain associated with compression of the dorsal root ganglion is caused by hyperexcitability of the dorsal horn neurons due to a loss of spinal GABAergic inhibition. Peripheral application of low-dose GABA-A receptor agonist can be useful to treat this pain.
Animals ; Back Pain ; Baclofen ; Bicuculline ; GABA-A Receptor Agonists ; GABA-A Receptor Antagonists ; GABA-B Receptor Agonists ; gamma-Aminobutyric Acid ; Ganglia, Spinal ; Hyperalgesia ; Hypersensitivity* ; Muscimol ; Neuralgia ; Posterior Horn Cells ; Rats* ; Receptors, GABA ; Spinal Cord

PURPOSE: Giant retinal cyst is formed by a localized and circumscribed splitting of the retina into two layers. It may often be confused with retinal detachment. We describe three cases of giant retinal cysts associated with retinal detachment associated with uveitis, and proliferative diabetic retinopathy. METHODS: A retrospective, observational case series. RESULTS: Two cases of giant retinal cyst were associated with uveitis: one detected during pars plana vitrectomy for total retinal detachment associated with chronic uveitis, and the other detected after scleral buckling procedure for retinal detachment associated with pars planitis. These cysts completely disappeared following drainage of fluid and laser photocoagulation to the flattened cyst. A case of retinal cyst secondary to proliferative diabetic retinopathy and vitreous hemorrhage was observed to be free of complication and progression without any surgical intervention for 9 months. CONCLUSIONS: Giant retinal cyst may result from intraretinal degenerative change caused by retinal capillary ischemia, vitreous traction and intraretinal leakage from the neovascularization. The cyst is considered to be stable without treatment in some cases, and in others it may be resolved with pars plana vitrectomy, fluid drainage and laser photocoagulation.
Capillaries ; Diabetic Retinopathy ; Drainage ; Ischemia ; Light Coagulation ; Pars Planitis ; Retina ; Retinal Detachment ; Retinaldehyde* ; Retrospective Studies ; Scleral Buckling ; Traction ; Uveitis ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: We performed transtibial single and double bundle reconstruction of the posterior cruciate ligament using the allo-achilles tendon and compared the results of single bundle reconstruction and double bundle reconstruction both clinically and radiologically. MATERIALS AND METHODS: This study included 41 cases of posterior cruciate ligament reconstruction between February 2000 and June 2007 that had data available for at least 2 years of follow-up. Twenty-two cases (53.7%) underwent single bundle reconstruction and 19 cases (46.3%) underwent double bundle reconstruction. Clinical results were analyzed by Lysholm score and IKDC standards scale, and the radiologic results were analyzed by the Telos(R) posterior translation test. RESULTS: The average Lysholm score at last follow-up was 85.4+/-4.7 in the single bundle group and 87.5+/-5.1 in the double bundle group. IKDC scores were grade A in 4 (18.2%), grade B in 14 (63.6%) and grade C in 4 (18.2%) in the single bundle group; they were 1 (15.3%), 15 (78.9%) and 3 (15.8%) in the double bundle group. Telos(R) posterior translation test scores were 5.06 mm (3.04-7.43 mm) in the single bundle group, and 4.04 mm (2.18-7.20 mm) in the double bundle group. There was significant improvement in clinical and radiological scores in both groups (p<0.001). However, these differences were not statistically significant (p>0.05). CONCLUSION: Further study with longer term follow-up is needed.
Follow-Up Studies ; Posterior Cruciate Ligament ; Tendons