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

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

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

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

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

BACKGROUND: It is a trend that the average life span is prolonged in proportion to the advance of socio-economy and medical science. Consequently, the number of elderly patients with skin diseases is increasing. OBJECTIVE: This study was performed to see the change of patterns of skin diseases in elderly patients. METHODS: One thousand four hundred and twenty elderly patients, over the age of 65, who visited the departments of dermatology and in five hospitals, from January 1, 1997 to December 31, 1997 were selected. We surveyed the frequeney of skin disease by types and the distributions by month, season and age.
Aged* ; Dermatology ; Epidemiologic Studies ; Humans ; Seasons ; Skin Diseases* ; Skin*

PURPOSE: Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total thyroidectomy. However the roles and indications of completion thyroidectomy remain controversial. This study was performed to review the clinical and pathologic features of patients who underwent completion thyroidectomy and to evaluate the safety of this procedure. METHODS: A retrospective analysis from Nov. 1994 to Dec. 2002 at Samsung Medical Center yielded 36 patients, 11 male and 25 female, who had undergone completion thyroidectomy. Their median follow-up was 29 months. RESULTS: The patients ranged in age from 20 to 58 years. Of the 36 patients, 24 had undergone prophylactic thyroidectomy and 12 therapeutic thyroidectomy for recurrence. The most common cause of completion thyroidectomy was cancers undiagnosed during the primary operation and 12 cases (75%) among these 16 undiagnosed cancers were follicular carcinoma. Three patients harbored carcinoma at the perithyroidal lymph node or remnant thyroid as a result of prophylactic completion thyroidectomy. Postoperative complications occurred in 11 patients (31%): 10 transient hypocalcemia and 1 transient hoarseness. There were no differences in postoperative complication rate between total thyroidectomy group and completion thyroidectomy during the same period at our hospital. CONCLUSION: The most common indication that is considered for completion thyroidectomy is a follicular carcinoma undiagnosed during primary operation. Completion thyroidectomy might be a safe operation with minimal morbidity if it is performed meticulously by an experienced surgeon.
Female ; Follow-Up Studies ; Hoarseness ; Humans ; Hypocalcemia ; Lymph Nodes ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy*

BACKGROUND: Porous beta-calcium pyrophosphate (beta-CPP) was developed to improve the fusion success of posterolateral lumbar fusion (PLF). The possibility of accomplishing PLF using a mixture of porous beta-CPP and iliac bone was studied. This paper reports the radiologic results of PLF using the beta-CPP plus autograft for lumbar degenerative disease as a bone graft extender. METHODS: A prospective, case-matched, radiographic study evaluating the results of short segment lumbar fusion using a beta-CPP plus autograft was performed to compare the efficacy of beta-CPP plus autograft with that of an autograft alone for short segment lumbar fusion. Thirty one consecutive patients (46 levels) underwent posterolateral fusion with pedicle screw fixation and additional posterior lumbar interbody fusion. In all patients, 3 mL of beta-CPP plus 3 mL of autogenous bone graft was placed randomly in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other. The fusion rates, volumes of fusion masses, and bone absorption percentage were evaluated postoperatively using simple radiographs and 3 dimensional computed tomography (3D-CT) scans. RESULTS: The control sides treated with an autograft showed significantly better Lenke scores than the study sides treated with beta-CPP at 3 and 6 months postoperatively, but there was no difference between the two sides at 12 months. The fusion rates (confirmed by 3D-CT) were 87.0% in the beta-CPP group and 89.1% in the autograft group, which were not significantly different. The fusion mass volumes and bone absorption percentage at 12 months postoperatively were 2.49 mL (58.4%) and 1.89 mL (69.5%) for the beta-CPP and autograft groups, respectively, and mean fusion mass volume was significantly higher in the beta-CPP group. CONCLUSIONS: beta-CPP combined with an autograft is as effective as autologous bone for grafting during instrumented posterolateral spinal fusion. These findings suggest that beta-CPP bone chips can be used as a novel bone graft extender for short-segment posterolateral spinal fusion.
Adult ; Aged ; *Bone Substitutes ; *Bone Transplantation ; Calcium Pyrophosphate/*administration & dosage ; Female ; Humans ; Ilium ; Imaging, Three-Dimensional ; Lumbar Vertebrae/radiography/*surgery ; Male ; Middle Aged ; Spinal Fusion/*methods ; Tomography, X-Ray Computed

Postoperative infections following spine surgery are usually attributable to bacterial organisms. Staphylococcus aureus is known to be the most common single pathogen leading to this infection, and the number of infections caused by methicillin-resistant Staphylococcus aureus is increasing. However, there is a paucity of literature addressing postoperative infection with Mycobacterium tuberculosis. We encountered a case of tuberculous spondylitis after spine surgery. A man had fever with low back pain three weeks after posterior interbody fusion with instrumentation for a herniated intervertebral disc at the L4-L5 level. He had been treated with antibiotics for an extended period of time under the impression that he had a bacterial infection, but his symptoms and laboratory data had not improved. Polymerase chain reaction for Mycobacterium tuberculosis turned out to be positive. The patient's symptoms finally improved when he was treated with antituberculosis medication.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology