Synovial chondromatosis is an uncommon lesion, which is characterized by cartilaginous and osseous metaplasia of the joint synovium. Synovial chondromatosis usually involves a large joint and rarely occurs in the hand. Intra-articular synovial chondromatosis during the hand should be considered in the differential diagnosis of swollen, stiff or painful joints. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection. Moreover, if enchondral ossification of loose bodies is not seen a diagnosis of synovial chondromatosis can not be made preoperatively. Intra-articular synovial chondromatosis is a benign condition and surgical synovectomy remains the most effective treatment. The authors report a case of synovial chondromatosis of the fifth metacarpophalangeal joint.
Arthritis, Rheumatoid ; Chondromatosis ; Chondromatosis, Synovial ; Diagnosis, Differential ; Gout ; Hand ; Joints ; Metaplasia ; Osteoarthritis ; Synovial Membrane

Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.
Anticonvulsants ; Benzodiazepines ; Myoclonus* ; Seizures ; Valproic Acid

Brain infarction restricted to the unilateral hypothalamus is known to be very rare because of the abundant blood supply from the circle of Willis. We report a case of right hypothalamic infarction. A 63-year-old woman developed hyperphagia, hypersomnolence and hemihyperhidrosis limited to the left half of the face. Brain MRI revealed a high signal intensity at the right anteromedial hypothalamus.
Brain ; Brain Infarction ; Circle of Willis ; Disorders of Excessive Somnolence* ; Female ; Humans ; Hyperphagia ; Hypothalamus ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged

Complications from hysteroscopy are relatively rare events. They occur more frequently with operative hysteroscopy than with diagnostic hysteroscopy. Air embolism is a rare but devastating complication of hysteroscopy that rightly receives attention as a frightening, sudden, and potentially fatal hazard in otherwise healthy women. We experienced one case of air embolism during diagnostic hysteroscopy for abnormal uterine bleeding under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevention of catastrophic outcomes and the hysteroscopists must understand the pathophysiology of air embolism to prevent, diagnose, and manage this potentially disastrous problem effectively.
Anesthesia, General ; Early Diagnosis ; Embolism, Air* ; Female ; Humans ; Hysteroscopy* ; Uterine Hemorrhage

BACKGROUND: To examine the influencing factors on patients' satisfaction in the emergency department(ED) far quality assurance. METHODS: Patients who visited to the ED were prospectively investigated from November 1 to December 31,1997. Authors developed questionnaire to investigate influencing factors on patients' satisfaction.4 Chi-square test and 115-REL 7.0 were applied far statistical analysis. RESULTS: Patients' satisfaction was significantly related to physical environment variables, accessibility variables, kindness of hospital personnel variables, and patient's trust for doctors variables. In path analysis, willingness for revisit was influenced by patients' satisfaction, accessibility, physical environment, patients' trust for doctors in order, and willingness for recommendation was influenced by accessibility, patients' satisfaction, and kindness of hospital personnel in order. CONCLUSIONS : The influencing factors on patients' satisfaction are physical environment, accessibility, kindness of hospital personnel, and patient's trust far doctors. Willingness far revisit and willingness far recommendation are influenced by patients' satisfaction. In spite of some limitations, the results of this study can be used as a baseline information for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the study of patients' satisfaction in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Personnel, Hospital ; Prospective Studies ; Surveys and Questionnaires

PURPOSE: We wanted to evaluate the incidence and causative factors of avascular necrosis (AVN) of the femoral head after intertrochanteric fracture. MATERIALS AND METHODS: Between 1994 and 2004, 383 cases of intertrochanteric fractures were internally fixed. Among them, 287 cases were followed more than one year; these cases were the subjects of this review. The average follow-up period was 5.3 years (range: 1.6 to 9.3 years). We retrospectively reviewed the medical records and radiographs of the patients who developed AVN of the femoral head after sustaining intertrochanteric fracture. RESULTS: Seven patients (2.4%) were found to have developed AVN during the follow-up. No patients were thought to be at risk for nontraumatic osteonecrosis of the femoral head due to steroid or alcohol abuse. Good reduction and good implant position were achieved in all patients. The duration from injury to the development of AVN was from 1 year to 3.8 years. The possible etiologies were initial vigorous trauma to the head and iatrogenic damage of the blood supply during reduction and fixation of the fracture. CONCLUSION: The patients who sustained inter trochanteric fracture should be monitored for development of AVN, and especially if there was an unstable fracture.
Alcoholism ; Femur ; Follow-Up Studies ; Head* ; Hip Fractures ; Humans ; Incidence ; Medical Records ; Necrosis* ; Osteonecrosis ; Retrospective Studies

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.
Intervertebral Disc ; Learning Curve ; Muscles ; Rehabilitation ; Ribs ; Skin ; Spinal Cord Injuries ; Superficial Back Muscles*

PURPOSE: To evaluate the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. MATERIALS AND METHODS: 25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores. RESULTS: The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results. CONCLUSION: Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.
Follow-Up Studies ; Fractures, Open ; Necrosis ; Postoperative Complications ; Skin ; Tibia ; Transplants

Tracheoesophageal fistula (TEF) is a rare disease which develops as a result of congenital or acquired causes. We report on two TEF female stroke patients with associated endotracheal intubation. Endotracheal intubation was kept for 13-14 days because of decreased mentality by intracranial hemorrhage. Recurrent pneumonia was a predominant symptom. Computed tomography and bronchoscopy were used to diagnose TEF. Both patients expired by sepsis and recurrent pneumonia before definite TEF treatment. The excessive dilatation of the cuff balloon of the endotracheal tube was considered one of the main causes of TEF. Prevention is most important and early treatment is required in this fatal disease.
Bronchoscopy ; Dilatation ; Female ; Humans ; Intracranial Hemorrhages ; Intubation, Intratracheal* ; Pneumonia ; Rare Diseases ; Sepsis ; Stroke ; Tracheoesophageal Fistula*

Tracheoesophageal fistula (TEF) is a rare disease which develops as a result of congenital or acquired causes. We report on two TEF female stroke patients with associated endotracheal intubation. Endotracheal intubation was kept for 13-14 days because of decreased mentality by intracranial hemorrhage. Recurrent pneumonia was a predominant symptom. Computed tomography and bronchoscopy were used to diagnose TEF. Both patients expired by sepsis and recurrent pneumonia before definite TEF treatment. The excessive dilatation of the cuff balloon of the endotracheal tube was considered one of the main causes of TEF. Prevention is most important and early treatment is required in this fatal disease.
Bronchoscopy ; Dilatation ; Female ; Humans ; Intracranial Hemorrhages ; Intubation, Intratracheal* ; Pneumonia ; Rare Diseases ; Sepsis ; Stroke ; Tracheoesophageal Fistula*