PURPOSE: To analyze the clinical results of debridement arthroplasty through a medial approach for primary osteoarthritis of the elbow. MATERIALS AND METHODS: Ten patients with primary osteoarthritis treated with debridement arthroplasty trough a medial approach were investigated. The ulnar nerve was transposed anteriorly in all patients. The mean duration of follow-up was 20.8 months. The clinical results were evaluated by measuring the preoperative and postoperative range of motion (ROM) of the elbow and using Mayo Elbow Performance Score (MEPS). RESULTS: The mean flexion contracture of the elbow joint was reduced from 23 degrees preoperatively to 10 degrees, postoperatively and the mean further flexion was improved from 93 degrees preoperatively to 131 degrees postoperatively. The mean MEPS improved from 55.3 points preoperatively to 86.9 points postoperatively. CONCLUSION: Debridement arthroplasty through a medial approach is considered as an useful method for primary osteoarthritis of the elbow.
Arthroplasty ; Contracture ; Debridement ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Osteoarthritis ; Range of Motion, Articular ; Ulnar Nerve

PURPOSE: To evaluate the usefulness of wrist arthroscopic examination in patient with persistent pain after the triquetral dorsal chip fracture and also to determine its relationship with TFCC injury in the triquetral dorsal chip fracture patient manifesting persistent pain. MATERIALS AND METHODS: This study is based on six cases presenting persistent pain in the ulnar aspect after the triqeutral posterior cord fracture that were treated conservatively. Wrist arthroscopy was carried out for all six cases. All were preoperatively and postoperatively evaluated using VAS pain scale, grip power, ulnar grind test, Kleinman shearing test and lunotriquetral ballottment test. RESULTS: Preoperatively, ulnar grind test yielded positive results in all six cases, Kleiman shearing test proved positive in three cases and lunotriquetral ballottment test yielded positive result in one case. In the arthroscopic findings, synovitis and TFCC injury were detected in all cases, and based on Palmer classification of TFCC injury, type IA was determined in five cases and type ID in one case. Arthroscopic TFCC partial resection and synovectomy were carried out. VAS pain scale improved from an average 8 points preoperatively to 3 points postoperatively. The difference of grip power between the normal and the other side improved from average of 15 lb preoperatively to 5 lb postoperatively. Based on postoperatively physical examination at 6 weeks, all cases yielded negative results in the ulnar grind test and Kleiman shearing test. CONCLUSION: We think that TFCC injury is one of the causes of persistent pain after triquetral dorsal chip fracture. We recommend an arthroscopic TFCC partial resection as a valuable treatment option.
Arthroscopy ; Hand Strength ; Humans ; Physical Examination ; Synovitis ; Wrist

STUDY DESIGNS: Retrospective analysis of the surgical treatment in patients of thoracolumbar spine fractures. OBJECTIVES: To measure by modified Cobb method the correction angle of thoracolumbar vertebral fractures and to comparison the difference between short segment pedicular fixation with fractured vertebra(group A) and without fractured vertebra (group B). SUMMARY OF LITERATURE REVIEW: The major treatment of thoracolumbar spine fractures is surgical correction of kyphotic angle by posterior decompression and posterolat. fusion at one level or more. MATERIALS AND METHODS: The materials are the patients who visited due to trauma beween 1991.1 and 2000.12. and treated by post. decompression and short segment posterolat. fusion with iliac bone graft. The number were A group, 28 persons and B group, 15 persons. The method of radiologic measurement is done by the modified Cobb method. The follow up time is till 2001.7. and the duration are minimal 6 months and maximal 77 months. The age was between 17 old and 60 old. The neurologic abnormalities in patients are 12 persons. The fractures were classified by the Denis classification. There are compressive fracture are 3 persons and bursting fracture type A are 18 persons, type B are 22 persons. The materials were confirmed by radiologic union and excluded if more than one vertebra fusion is needed. RESULTS: The most fractures were due to falldown injury. The most fracture site was T-L level (T12-L3). The one case was complicated by deep infection and treated and the other case was reduction loss due to metallic failure. The results of the loss of correction were A group, 5.3 degree and B group, 6.2 degree. (P>0.05). The relative correction loss were A group, 42%, and B group, 54%. (P<0.05). CONCLUSION: The mean correction angle and loss of correction are more good results in the group of short segment pedicular fixation with fracture vertebra. But to get more good results, our study do more long term follow-up and rule out other statistical errors and consecutive radiologic follow-up.
Classification ; Decompression ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spine* ; Transplants

Epiphrenic diverticulum is a relatively rare condition resulting from mucosal herniation through the muscular wall of the esophagus. This pulsion diverticulum is often associated with abnormal esophageal motility such as esophageal achalasia. Although pneumatic dilatation is recommended as the initial treatment for patients with esophageal achalasia, some authors caution against the use of pneumatic dilatation when esophageal achalasia is complicated by epiphrenic diverticulum. A 49-year old female patient was admitted due to progressive dysphagia for both solid and liquid foods, and weight loss and frequent vomiting. She suffered from Heller's myotomy due to esophageal achalasia 8 years prior. She was diagnosed as having recurrent esophageal achalasia with epiphrenic diverticulum due to incomplete myotomy, using esophagography, esophagogastrodudenoscopy, esophageal manometry, and esopahgeal transit scan. The patient was successfully treated with pneumatic balloon dilatation, and her symptoms markedly improved.
Deglutition Disorders ; Dilatation ; Diverticulum* ; Esophageal Achalasia* ; Esophagus ; Female ; Humans ; Manometry ; Middle Aged ; Vomiting ; Weight Loss

Epiphrenic diverticulum is a relatively rare condition resulting from mucosal herniation through the muscular wall of the esophagus. This pulsion diverticulum is often associated with abnormal esophageal motility such as esophageal achalasia. Although pneumatic dilatation is recommended as the initial treatment for patients with esophageal achalasia, some authors caution against the use of pneumatic dilatation when esophageal achalasia is complicated by epiphrenic diverticulum. A 49-year old female patient was admitted due to progressive dysphagia for both solid and liquid foods, and weight loss and frequent vomiting. She suffered from Heller's myotomy due to esophageal achalasia 8 years prior. She was diagnosed as having recurrent esophageal achalasia with epiphrenic diverticulum due to incomplete myotomy, using esophagography, esophagogastrodudenoscopy, esophageal manometry, and esopahgeal transit scan. The patient was successfully treated with pneumatic balloon dilatation, and her symptoms markedly improved.
Deglutition Disorders ; Dilatation ; Diverticulum* ; Esophageal Achalasia* ; Esophagus ; Female ; Humans ; Manometry ; Middle Aged ; Vomiting ; Weight Loss

No abstract available.

Collagen and its products, used in some medical field are relatively safe but may induce hypersensitivity reaction. However, pulmonary embolism is a rare but serious complication after injection of them. A-48-year old woman was admitted because of cough, hemoptysis and dyspnea. Nine days ago, she had received breast augmentation with injectable collagen by unlicensed person. Four days later, she experienced cough, hemoptysis and dyspnea. On admission right side pleural effusion and peripheral distributed diffuse consolidations in both lungs were noted on chest radiograph. A computed tomographic (CT) scan of the chest showed non-segmental distribution of bilateral ground-glass opacity and interlobular septal thickening with multifocal consolidation in both lungs. Sputum and urine cytologic examination revealed foamy histiocytes containing lipid vaculoes. Conservative management was done under the impression of pulmonary embolism after collagen injection. She was dischared with full recovery. Here, we report a case of pulmonary embolism occurred after infection of collagen first in Korea.
Breast ; Collagen* ; Cough ; Dyspnea ; Female ; Hemoptysis ; Histiocytes ; Humans ; Hypersensitivity ; Korea ; Lung ; Pleural Effusion ; Pulmonary Embolism* ; Radiography, Thoracic ; Sputum ; Thorax

BACKGROUND: Significant increases in the prevalence of obesity have been observed among patients with peritoneal dialysis (PD). The impact of body mass index (BMI) on survival remains unknown in Korean PD patients. METHODS: Among data of 80,674 patients on PD acquired from the Insan Memorial ESRD Registry database for the years 1985 to 2014, 6,071 cases were analyzed. Subjects were classified by baseline BMI; < 21.19 kg/m² (quartile 1, n = 1,518), 21.19 to 23.18 kg/m² (quartile 2, reference; n = 1,453), 23.19 to 25.71 kg/m² (quartile 3, n = 1,583), and > 25.71 kg/m² (quartile 4, n = 1,517). RESULTS: Mean age was 65.8 years, and baseline BMI was 23.57 kg/m². Numbers of male and diabetic patients were 3,492 (57.5%) and 2,192 (36.1%), respectively. Among 6,071 cases, 2,229 (36.7%) all-cause deaths occurred. As a whole, Kaplan–Meier survival curves according to BMI quartiles was significantly different (P = 0.001). All-cause mortality was significantly higher in quartile 4 than in the reference (hazard ratio [HR] = 1.154, 95% confidence interval [CI], 1.025–1.300; P = 0.018). There was no statistical difference in all-cause mortality among BMI quartiles in diabetic patients on PD. In non-diabetic patients, all-cause mortality of quartiles 1 and 3 was not different from the reference, but the HR was 1.176 times higher in quartile 4 (95% CI, 1.024–1.350; P = 0.022). CONCLUSION: Baseline BMI > 25.71 kg/m² seems to be an important risk factor for all-cause mortality in Korean PD patients.
Body Mass Index ; Diabetes Mellitus ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Mortality ; Obesity ; Peritoneal Dialysis ; Prevalence ; Risk Factors

Self-expandable metallic stent (SEMS) has been reported to provide effective treatment alternatives with minimal morbidity for patients with malignant gastroduodenal obstruction. Limitations of SEMSs are stent occlusion due to tumor ingrowth or overgrowth and stent migration. Migrated stents may remain in the stomach or travel distally. To our knowledge, however, migration of pyloric SEMS to the esophagus has not been reported. We experienced such a case in a 65-year-old woman who had undergone a gastrojejunostomy and choledochojejunostomy due to unresectable pancreatic head cancer. Pyloric SEMSs (Niti-S Pyloric Bare Stent, 18x60 mm, Taewoong Medical, Korea) were deployed at the obstructed efferent and afferent loops. After severe vomiting, a pyloric SEMS placed at the afferent loop migrated into the esophagus, which caused severe chest pain and intractable hiccup. It was removed endoscopically. This case illustrates that pyloric SEMS can migrate to the esophagus through the lower esophageal sphincter.
Aged ; Chest Pain ; Choledochostomy ; Esophageal Sphincter, Lower ; Esophagus* ; Female ; Gastric Bypass ; Gastric Outlet Obstruction ; Head and Neck Neoplasms ; Hiccup ; Humans ; Pancreatic Neoplasms ; Stents* ; Stomach ; Vomiting

BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.
Amylases ; Bile Ducts* ; Bile* ; Choledocholithiasis ; Common Bile Duct ; Dilatation* ; Diverticulum ; Epinephrine ; Hemorrhage ; Humans ; Inflation, Economic ; Lipase ; Mortality ; Pancreatitis ; Sphincterotomy, Endoscopic*