Recently there has been a noted increase in the incidence of traumatic bony gap in long bones due to accidents in industry, high speed traffic accidents and common gunshot accidents. There are several methods to treat traumatic bony gap such as bone graft (autogenous, homogenous and heterogenous), bone transplantation, periosteal osteogenesis and reinplantation of the extruded bone etc. The authors studied 26 patients of traumatic bony gap in the long bones which had been treated by autogenous bone grafting. The results of the clinical observation were as following; 1 The causes were shotgun accidents, vehicle accidennts and explosive accidents. 2 There was bony gap involved in 10 upper extremities and 16. lower extremities. The radius was the most common site in the upper extremity and the femur in the lower extremity. 3. The largest bony gaps were 10.5cm. in the tibia and next were 10.6cm. in ulna and 9.0cm. im humerus. 4. The period of the bony union in these cases was prolonged 1.5~3 times the usual healing period of simple fractures. 5. It was very important to prevent and control infection of the open fractures and to decide the correct time for bone grafting operation after healing of the infected wounds. We did the bone grafting sugery 2 or 3 months later after the infected wounds had been healed. 6 The authors could avoid some complications such as delayed union, shortening of the affected limbs and stiffness of the joints of the affected limbs etc.
Accidents, Traffic ; Bone Transplantation ; Extremities ; Femur ; Fractures, Open ; Humans ; Humerus ; Incidence ; Joints ; Lower Extremity ; Osteogenesis ; Radius ; Tibia ; Transplants ; Ulna ; Upper Extremity ; Wounds and Injuries

Rupture of Achilles tendon was first reported by Pare, 1575 and thereafter the cause and the diagnostic and therapeutic methods of the ruptured tendon have been described by many workers. Rupture of the Achilles tendon is often wrongly diagnosed and inadequately treated by the doctor who first sees it, with consequent problems of treatment and prognosis. In this paper 24 patients(25 cases)
Achilles Tendon ; Female ; Follow-Up Studies ; Humans ; Male ; Methods ; Prognosis ; Rupture ; Tendons

PURPOSE: During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity. METHODS: We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated. RESULTS: The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%. CONCLUSION: Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.
Breast ; Breast Neoplasms ; Dietary Sucrose ; Humans ; Lymph Nodes ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy

No abstract available.
Headache* ; Humans

OBJECTIVE: This study was undertaken to study pedicle morphology in Koreans to provide a reference guide in transpedicular screw fixation. METHODS: Pedicle measurements were obtained from 35 dried human lumbar columns(175 lumbar vertebrae). Anatomic evaluation was focused on pedicle transverse diameter, pedicle axis length and the distance from the pedicle axis point to the midline of the transverse process. Pedicle angle and vertebral body length also were measured. RESULT: In the transverse plan, pedicle diameter increased from L1(7.8mm) to L5(15.5mm). But in 20.0% of L1 and L2, its diameters was under 6.0mm. In the sagittal plan, it was not as constant and had similar diameter from L1 to L5. In the transverse plan, the pedicle angle increased from L1 to L5. But in the sagittal plan it decreased from L1 to L5. Also, the pedicle axis length did not show concordant change, but rather had similar length in lumbar vertebrae. In 15%, its length was under 45mm. CONCLUSION: These results suggest that using above 6mm diameter and 45mm length of screw for L1 and L2 can violate the pedicle and vertebrae. Above L4, the pedicle axis point was superior to the midline of the transverse process, below L4, it was inferior to the midline of the transverse process. This information may prove to be helpful when contemplating the placement of screws to the lumbar pedicles.
Axis, Cervical Vertebra ; Humans ; Lumbar Vertebrae* ; Spine

PURPOSE: Although sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND). MATERIALS AND METHODS: We analyzed 1,886 patientswho underwent ALND after negative results of SLNB, retrospectively. A logistic regression analysis was used to identify risk factors associated with a false-negative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS). RESULTS: Tumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS. CONCLUSION: In patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.
Biopsy* ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Logistic Models ; Lymph Nodes ; Odds Ratio ; Prognosis ; Retrospective Studies ; Risk Factors* ; Sentinel Lymph Node Biopsy

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.
Aneurysm ; Angiography ; Endocarditis ; Follow-Up Studies ; Heart ; Heart Failure ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Rupture

PURPOSE: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. Bohler angle and Gissane angle were 7.6 degrees, 102.4 degrees, and it increased to 23.5 degrees, 128.6 degrees after postoperative 1 year. CONCLUSION: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.
Calcaneus* ; Humans ; Intra-Articular Fractures* ; Retrospective Studies

PURPOSE: Contrast media-induced nephropathy (CIN) following coronary angiography is associated with an increased mortality and morbidity. We investigated the incidence of nephrotoxicity, clinical characteristics, laboratory characteristics and risk factors of CIN in patients undergoing coronary angiography. METHODS: We retrospectively evaluated the medical records of 555 patients who had undergone coronary angiography at the Sanggye Paik Hospital, from January 2004 to December 2005. We defined CIN as any increase in the creatinine value of more than 0.5 mg/dL or 50% of baseline value. RESULTS: Among 555 patients, CIN developed in 10 of 48 patients (20.8%) with renal insufficiency (serum creatinine > or =1.4 mg/dL) and in 7 of 507 patients (1.4%) without renal insufficiency (p<0.001). Decreased renal function, congestive heart failure, higher baseline uric acid, lower baseline albumin and age > or =65 years were the significant predictors of CIN. There were no statistical differences in contrast type and volume according to the development of CIN. CONCLUSION: Our data supported the assumption that renal insufficiency, congestive heart failure, hyperuricemia and anemia may be the risk factors of developing CIN.
Anemia ; Contrast Media ; Coronary Angiography ; Creatinine ; Heart Failure ; Humans ; Hyperuricemia ; Incidence ; Medical Records ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Uric Acid

BACKGROUND: The incidence of tetanus in adults and neonatal tetanus have been markedly reduced by world-wide use of DTP vaccines. But, tetanus is still one kind of major health problems in many developing countries, and several serosurvey stduies in developed countries revealed that substantial proportions of adult population may lack immunity against tetanus and immunity level against tetanus is continuously decreasing by age. In Korea, tetanus outbreaks have been disappeared since the 1980s by high acceptant DTaP vaccination rates. Annually, few tetanus patient has been reported since 1990s. But, there have been no seroepidemiological studies to tetanus, no trials to assess tetanus immunizations. And we do not use Td vaccine in adults for maintaning tetanus immunity. In this aspect, we conducted age related survey of immunity to tetanus and indirectly assessed the immunogenecity of tetanus vaccines, used in Korea. METHODS: For the evaluation of age related serosurvey of tetanus immunity in Korean population, study subjects were classified into 16 groups (A~J group; below 10 years with one year interval, K~O group; 11~60 yrs with 10 years interval, P group; over 60 yrs). The numbers of each group were 100, and sex distributions of each group were almostly equal. And for the indirect assessment of tetanus immunization in Korean children, children under 15 years old age were classified into 6 groups (I~VI) according to the status of DTaP vaccination. The numbers of this each group were 50, and sex ratio was almostly equal. Specific IgG antibody to tetanus toxin were detected by ELISA. And the ANOVA repeated t-test was used to compare antibody levels in study groups. RESULTS: In age related groups, the antibody levels to tetanus toxin were well maintained until 20 years old age group (L group), but thereafter the titers abruptly decreased below 0.1 IU/mL and over 75% populations among the groups over 30 years old age needed maintenance of protective immunity to tetanus. The antibody level of male was statistically higher than that of female in P group. In the groups related DTaP vaccination status, the antibody titer was very low in prevaccination group (I), but the titers after primary vaccinations were sharply increased and highly maintained until 15 years. CONCLUSOIN: The results of our study revealed that the immunity to tetanus was dramatically decreased in age groups over 30 years old. This result indicates that Td vaccination program in adults should be considered for maintenance of immunity to tetanus. And our study indicate that DTaP vaccination programs and vaccines, used in Korea, are effective for acquisition and maintenance of tetanus immunity in Korean children.
Adolescent ; Adult ; Child ; Developed Countries ; Developing Countries ; Disease Outbreaks ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunization ; Immunoglobulin G ; Incidence ; Korea ; Male ; Seroepidemiologic Studies ; Sex Distribution ; Sex Ratio ; Tetanus Toxin ; Tetanus* ; Vaccination ; Vaccines ; Young Adult