Infection in primary total hip arthroplasty may cause catastrophic results and is the major reason for implant failure. The purpose of this study was to evaluate the utility of the hip joint fluid culture as a method of predicting the possibility of a hip joint infection by calculating the sensitivity, specificity and accuracy. We performed 628 primary total hip arthroplasty and aerobic and anaerobic bacterial cultures for hip joint fluid between January 1989 and June 1996. The hip joint fluid culture was routinely performed to evaluate the utility of the femoral head for bone banking. Thirty-two cases out of the 628 hips showed positive intraoperative culture and 596 cases showed negative intraoperative culture. The isolated organisms from 32 positive cultures were 11 for Staphylococcus aureus, eight for Staphylococcus coagulase negative, seven for Enterococcus, three for E.coli and one each for Enterobacter, Acinetobacter and Pseudomonas. Anaerobic culture was negative in all cases. In the positive intraoperative culture cases, none had delayed infection during the follow-up period. But in the negative intraoperative culture cases, one case had acute infection and two cases had delayed infection. In the case with acute infection, Staphylococcus aureus was isolated and on two cases with delayed infection, Enterococcus and Staphylococcus coagulase negative were isolated, respectively. All 32 positive culture cases were fa~lse positive and 595 negative culture cases were true negative and one negative culture case was fa~lse negative. The sensitivity of the hip joint culture was 0%, the specificity was 94.9% and the accuracy was 0%. The specificity of hip joint fluid culture in primary total hip arthroplasty was high, hut the sensitivity score was zero. Therefore, the hip joint fluid culture should not be used for a routine check of infection status in primary total hip arthroplasty. We recommend the hip joint fluid culture in revision arthroplasty or hips in which infection is clinically suspected.
Acinetobacter ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bone Banks ; Coagulase ; Enterobacter ; Enterococcus ; Follow-Up Studies ; Head ; Hip Joint* ; Hip* ; Pseudomonas ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

OBJECTIVE: The purpose of this study was to examine the relationship between attachment and behavior problems in adolescents. METHOD: A sample of 792 high school students were examined. Revised Adult Attachment Scale, Self-report Attachment Style, Youth Self-Report Child Behavior Checklist (YSR) were used to measure the attachment quality, the attachment pattern and the behavior problems respectively. RESULTS: As to the attachment quality, high score in fear of rejection, low dependability and low intimacy were related to the development of adolescent's internalizing problems. As to the attachment pattern, preoccupied and fearful with attachment experience were linked to the internalizing behavior problems of higher level as well as 'Attention problems' and 'Aggressive behavior' sub-scales of externalizing ones on YSR. CONCLUSION: High fear of rejection, low dependability and low intimacy characterise the insecure attachment. So the insecure attachment might predict the development of all internalizing behavior problems, attention problems and aggressive behavior in adolescents. Also the result suggested that the adolescents classified as Dismissing attachment may have a positive view of the self and may minimize the self reported behavior problems.
Adolescent* ; Adult ; Checklist ; Child ; Child Behavior ; Humans ; Self Report

Objective: To investigate whether baseline olfactory dysfunction in Parkinson’s disease (PD) patients is associated with baseline and longitudinal motor and cognitive function. Methods: We recruited 228 drug-naïve PD patients who were followed for a mean of 6 years. Patients underwent the Cross-Cultural Smell Identification Test (CCSIT), a neuropsychological test, and N-(3-[18F]fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography within 6 months of the baseline evaluation. Olfactory dysfunction was categorized as normosmia (CCSIT score ≥ 9), hyposmia (CCSIT score 5–8), and anosmia (CCSIT score ≤ 4). During the follow-up period, we investigated changes in the levodopa-equivalent dose (LED) and the occurrence of wearing-off, levodopa-induced dyskinesia, and dementia. Results: Among the PD patients, 80.7% were hyposmic at the time of diagnosis, and 26.1% were anosmic. Baseline olfactory dysfunction was not associated with either initial parkinsonian motor symptoms or with the longitudinal LED increment and motor complications. Meanwhile, the anosmic group had lower baseline scores on the Korea version of the Boston Naming Test and Stroop color reading test than the normosmic and hyposmic groups. The anosmic group exhibited a higher rate of conversion to dementia than the normosmic [adjusted hazard ratio (HR) 3.99, 95% confidence interval (CI) 1.08–14.72] and hyposmic (adjusted HR 2.48, 95% CI 1.15–5.32) PD groups, regardless of baseline motor deficits and cognitive status. Conclusion Baseline olfactory dysfunction was not associated with motor deficits and complications, but it was associated with cognitive dysfunction and prognosis, suggesting that severe olfactory impairment may reflect early cortical involvement, probably in the frontotemporal region, and rapid spreading of Lewy body pathology.

PURPOSE: A 6-year-old boy with osteogenic sarcoma of the left humerus underwent bone scintigraphy. Tc-99m MDP was accumulated not only in the primary tumor but also in the osseous and extraosseous (pulmonary and pericardial) metastases. Osteogenic sarcoma directly produces osteoid, both in the primary and metastatic lesions. Tc-99m MDP is avidly taken up by tumor osteoid. At initial presentation, only 2% of cases have both pulmonary and osseous metastases. The patient had osseous, pulmonary, and pericardial metastases at presentation. This case presents that increased uptakes of Tc-99m MDP by the primary and metastatic tumor were demonstrated on bone scintigraphy at presentation.
Child ; Humans ; Humerus ; Male ; Neoplasm Metastasis* ; Osteosarcoma* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate

PURPOSE: We underwent this study to evaluate the factors which influence labeling efifciency when modified in vivo erythrocyte labeling technique was used. MATERIALS AND METHODS: Thirty healthy volunteers (M: F=19: 11, age: 25 +/- 2 yrs) were enrolled in this study. Totally, two hundred ten samples were obtained from them. The 1 mg of stannous pyrophosphate was injected intravenously at the beginning of labeling. After suitable tinning time (5 min, 20 min, 35 min) passed by, blood (5 mL, 3 mL or 1 mL) was withdrawn into 10 mL syringe previously containing Tc-99m (740 MBq) and anticoagulant (heparin, ACD or CPDA) through 19-gauged scalp needle. The generator ingrowth time of Tc-99m was within 24 hrs in each case. The blood samples were placed on rotating invertor during incubation (10 min, 25 min, 40 min) but some of them were not. Immediately after the conclusion of incubation, the labeled blood specimens to analyze were centrifuged. and then %Unbound Tc-99m was calculated. Statical analysis was used paired T-test and one way ANOVA with SPSS 10.0. RESULTS: The binding efficiency at 1 mL of blood volume was 73 +/- 32%, 91 +/- 10% at 3 mL and 96 +/- 7% at 5 mL (p< 0.01). The binding efficiency at 5 min of tinning time was 45 +/- 23%, 98 +/- 6% at 20 min and 97 +/- 8% at 35 min (p< 0.001). The binding efficiency at 10 min of incubation time was 96 +/- 7%, 95 +/- 12% at 25 min and 98 +/- 3% at 40 min (p> 0.05). The binding efficiency in case of using rotating invertor was 96 +/- 7% and the binding efficiency in case of not using it was 87 +/- 18% (p> 0.05). There was no significant difference between them. In binding efficiency according to kinds of anticoagulants, ACD was 98 +/- 4%, CPDA was 97 +/- 6% and heparin was 89 +/- 20% (p< 0.001). CONCLUSION: When modified in vivo erythrocyte labeling technique is used with Tc-99m, the methods to obtain the highest labeling efficiency are as follow. The withdrawing blood volume should be over 3 mL, tinning time should be kept between 20 min and 35 min, and incubation time should be kept between 10 min and 40 min. ACD or CPDA have to be used as a anticoagulant except heparin and the blood samples should be placed on rotating invertor during incubation.
Anticoagulants ; Blood Volume ; Erythrocytes* ; Healthy Volunteers ; Heparin ; Needles ; Scalp ; Syringes ; Tin

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

PURPOSE: Fast MRI has provided detailed and reproducible fetal anatomy. This study was performed to evaluate the usefulness of fetal MRI for prenatal diagnosis. MATERIALS AND METHODS: Fifty-six fetuses with congenital abnormalities on ultrasonography were evaluated by fetal MRI from 2001 to 2004 in Severance Hospital. Final diagnosis was made by postnatal pathology, postnatal MRI, and other modalities (such as ultrasound, retrograde pyelogram). A 1.5-Tesla superconductive MR imaging unit was used to obtain half-Fourier acquisition single-shot turbo spin images. RESULTS: Of the 56 fetuses, intracranial abnormalities were found in 26 fetuses, intraabdominal abnormalities in 17 fetuses, intrathoracic in 6 fetuses, head and neck in 5 fetuses, and other sites in 2 fetuses. There were six cases in which the diagnoses of fetal MRI and ultrasonography differed. In such cases, fetal MRI provided more exact diagnosis than ultrasonography (5 vs. 0). Three fetuses with intracranial abnormalities on ultrasonography were diagnosed as normal by fetal MRI and in postnatal diagnosis. CONCLUSION: Although ultrasonography is known as a screening modality of choice in the evaluation of fetus because of the cost-effectiveness and safety, the sonographic findings are occasionally inconclusive or insufficient for choosing the proper management. Thus, in this study, we suggest that fetal MRI is more useful than ultrasonography for the evaluation of intracranial abnormalities in some instances. For prenatal counseling and postnatal treatment planning, fetal MRI can be informative when prenatal ultrasonography is inadequate and doubtful.
Female ; Fetal Diseases/*diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Pregnancy ; Prenatal Diagnosis/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography, Prenatal

Ovarian cysts are the most frequent, prenatally diagnosed intra-abdominal cysts. Fetal ovarian cyst often presents complication such as torsion and seems to be an indication for surgical intervention. In this study, we reviewed pre- and post-natal medical records and ultrasonography of 17 fetuses that were diagnosed with ovarian cysts. In a total of 17 cases, postnatal surgery was performed in 7 infants. Of these cases, four cases of ovarian cyst torsion were confirmed. In the remaining 10 fetuses, one case regressed completely during pregnancy, and the other nine cases including two complex cysts resolve spontaneously after birth. Postnatal symptomatic cysts or cysts with a diameter greater than 5 cm that do not regress or enlarge should be treated, but uncomplicated asymptomatic cysts less than 5 cm in diameter should only be observed and reassessed by serial ultrasonography. If they regress spon-taneously, no surgical intervention is necessary independent of their sonographic findings.
Ultrasonography, Prenatal/*methods ; Remission, Spontaneous ; Pregnancy ; Ovariectomy/methods ; Ovarian Cysts/*diagnosis/surgery ; Infant, Newborn ; Infant ; Humans ; Gestational Age ; Fetal Diseases/*diagnosis/surgery ; Female

Foreign bodies in the gastrointestinal (GI) tract can be seen in all age groups and is not uncommon to see in the emergency department. Most are pediatric, edentulous, incarcerated and/or psychiatric patients. Since ingested objects are expected to pass spontaneously in 80% to 90% of patients with normal anatomy, direct foreign body removal using surgical intervention is rarely required. However, an ingested toothpick is of surgical interest as a cause of significant morbidity and even mortality. This is due to the difficulty in preoperative diagnosis resulting from a lack of history of ingestion of the toothpick and to the toothpick's radiolucent qualities. We report the case of a patient with peritonitis due to perforation of the sigmoid colon, a complication of accidental ingestion of a toothpick, that was diagnosed at the surgical field. Related literature is reviewed together.
Colon* ; Colon, Sigmoid ; Diagnosis ; Eating ; Emergency Service, Hospital ; Foreign Bodies ; Humans ; Mortality ; Peritonitis

Abdominal pregnancies are rare forms of ectopic pregnancies. Although the pelviccavity is the preferential site, a small fraction of abdominal pregnancies has been found inthe upper abdominal cavity, e.g., the omentum, the spleen, the liver etc. In this manuscript,we first report a Korean case of hepatic pregnancy which was highly suggested by operativefindings. A 24-year-old woman underwent laparotomy under the impression ofhemoperitoneum and ectopic pregnancy. An 1 x 1x 0.5cm sized mass was removed from thesurface of the right lobe of the liver. Microscopically, the chorionic villi were demonstrated.The patient had a successful recovery.
Abdominal Cavity ; Chorionic Villi ; Female ; Humans ; Laparotomy ; Liver* ; Omentum ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic ; Spleen ; Young Adult