Dislocation of the clavicle at its sternal end is relatively rare, as compared with acromioclavicular dislocation. Among them, the posterior dislocation of the sternoclavicular joint was extremely rare. So, not more than fifty cases had been reported in the literature. Of these three main typesanterior, superior, and posterior-the anterior one is by far the most common. Most authors have stressed the difficulty in confirming the diagnosis with routine radiographs. We experienced a case of traumatic posterior dislocation of the sternoclavicular joint treated successfully by manipulative reduction. So, we report it with review of literature.
Clavicle ; Diagnosis ; Dislocations ; Sternoclavicular Joint

Osteopetrosis is a very rare bone dysplasia characterized by failure of resorption and persistence of calcified chondroid and primitive bone. In 1904 Albers-Schonberg first described the radiological appearance of marble bone. This is named osteopetrosis by Karshner in 1926. A fulminating form is manifested from birth in which fractures and deformity, hydrocephalus and cranial nerve palsies lead to early death from intractable anemia and intercurrent infection. In other cases the stigmata are delayed until later childhood, when retardation of growth and of mental and sexual development occurs, and not infrequently accompanied by rickets, dental caries and osteomyelitis. We have experienced a familial osteopetrosis, father and three siblings, which was thought to be a autosomal dominant inheritance. One of those family, 20 years old man, has been complained of anemia and low back pain without radiating pain to the lower extremities. The other 3 patients has not been complained of any other clinical symptoms. But X-Ray examination of the entire skeletal survey of those members of the family have revealed the uniform opacity of long bones and flat bones.
Anemia ; Bone Diseases, Developmental ; Calcium Carbonate ; Christianity ; Clothing ; Congenital Abnormalities ; Cranial Nerve Diseases ; Dental Caries ; Fathers ; Humans ; Hydrocephalus ; Low Back Pain ; Lower Extremity ; Osteomyelitis ; Osteopetrosis ; Parturition ; Rickets ; Sexual Development ; Siblings ; Wills

Epidural nerve block is the most widely practiced procedure in the pain clinic. Accidental dural puncture during epidural nerve block also has been associated with postdural puncture headache and total spinal anesthesia. Especially, total spinal anesthesia is the most serious complication of epidural nerve block and can lead to a life threatening conditions. We have experienced two cases in whom total spinal anesthesia occurred during epidural nerve block for neck and lower back pain control. Immediately after epidural nerve block, the patients became unresponsive and apneic with loss of muscle tone in all extremity. We performed resuscitations and about 3 hours later the patients recovered completely without any complication.
Anesthesia, Spinal* ; Extremities ; Humans ; Low Back Pain ; Neck ; Nerve Block* ; Pain Clinics ; Post-Dural Puncture Headache ; Punctures ; Resuscitation

No abstract available.
Dislocations* ; Tendons*

No abstract available.
Osteochondroma*

PURPOSE: The aim of this study was to demonstrate that the combined systemic administration of apomorphine (APO) and sildenafil have a synergistic effect on the erection in conscious rabbits. MATERIALS AND METHODS: The erections of the male New Zealand White rabbits (2-3kg, n=12) were assessed by measuring the length of the uncovered penile mucosa (LUPM) and duration of the erection, both before and after the intravenous administration of agents. After the injection of APO (0, 0.05, 0.1, 0.4mg/kg), sildenafil was administered intravenously in a dose-response manner (0.5, 1, 5mg/kg), followed by measurements for 0-120 minutes. In additional experiments, the effect of increasing the dosages of sildenafil, combined with APO, on blood pressure were evaluated. RESULTS: The intravenous administration of sildenafil caused a concentration dependent increase in the LUPM. There was a statistically significant increase in the LUPM with the administration of APO compared with no administration. The dosages of sildenafil and APO showing the greatest efficacy of sildenafil potentiation were 1mg/kg and 0.1 mg/kg, respectively. The intravenous administration of APO at a dose of 0.1mg/kg was more effective than those of 0.05 and 0.4mg/kg, with dosages of sildenafil of 0.5 and 1mg/kg. There was no additional increase in the duration of erection on the administration of APO. The intravenous administration of sildenafil caused a concentration dependent decrease in blood pressure, but there was no additional decrease on administration of the APO. CONCLUSIONS: We have shown that apomorphine elicits a stronger response on the erection induced by sildenafil in conscious rabbits, with no additional decrease in blood pressure.
Administration, Intravenous ; Apomorphine* ; Blood Pressure ; Humans ; Male ; Mucous Membrane ; Penile Erection* ; Rabbits* ; Sildenafil Citrate

PURPOSE: The factors for predicting persistent urge symptom and urge incontinence following a tension-free vaginal tape (TVT) procedure were investigated in patients with mixed urinary incontinence. MATERIALS AND METHODS: Two hundred and seventy-four women, with a mean age of 55 years, ranging from 28 to 80, with female urinary incontinence (stress urinary incontinence; 201, mixed urinary incontinence; 73) were the subjects of this study. After a TVT procedure, the patients were followed up at 1, 6 and 12 months and every 1 year thereafter. Cure of incontinence after the procedure was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, with all other cases considered as failures. RESULTS: There was no significant difference in the cure rates for stress urinary incontinence in patients with stress and mixed urinary incontinence. However, of 73 patients with mixed urinary incontinence, 20 (27.4%) ans 12 (16.4%) had persistent urgency and continued urge incontinence, respectively. In a multivariate analysis, a low maximal urethral closure pressure (MUCP) was found to be associated with an increased likelihood of persistent urgency (odds ratio, 0.94; 95% confidence interval, 0.38-0.99; p=0.029) and the persistent urge incontinence (odds ratio, 0.94; 95% confidence interval, 0.88-0.99; p=0.030) after a TVT procedure in patients with mixed urinary incontinence. CONCLUSIONS: Our findings suggest that a low MUCP may be associated with the persistent urgency and urge incontinence after a TVT procedure in patients with mixed urinary incontinence.
Exercise Test ; Female ; Humans ; Multivariate Analysis ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Urge*

BACKGROUND AND OBJECTIVES: A variety of experimental heterotopic heart transplantation models have been developed for the purpose of this study. However most were complicated and used extracorporeal circulation. A new and simple experimental working heterotopic intrathoracic heart transplantation model has been developed in dogs, which could be performed without support of extracorporeal circulation. MATERIALS AND METHODS: Six mongrel dogs were used for the three heterotopic heart transplantation experiments. The heterotopic hearts were transplanted in the right thoracic cavity using a right thoracotomy. The superior vena cava and left atrial cuff of the donor heart was anastomosed to the superior vena cava and left atrium of the recipient heart. Consequently, the aorta and pulmonary artery were anastomosed to the ascending aorta and right atrial appendage of the recipient heart, without cardiopulmonary bypass. The electrocardiograms of the donor and recipient hearts were measured by electrodes placed at the ventricular apexes and on the skin. RESULTS: The donor hearts survived for 10, 6 and 18 days after transplantation, without any immunosuppressive agents or anticoagulants. The electrocardiograms of both hearts could be measured using the electrodes. There were no wave or voltage changes on electrocardiography. CONCLUSION: This working heart model of heterotopic intrathoracic transplantation, without cardiopulmonary bypass, may be useful in studies for various purposes, i.e., the effects of different pharmacological agents on the conduction system of the denervated heart and the hemodynamic changes of the recipient with auxiliary support of the transplanted heart.
Animals ; Anticoagulants ; Aorta ; Atrial Appendage ; Cardiopulmonary Bypass* ; Dogs ; Electrocardiography ; Electrodes ; Extracorporeal Circulation ; Heart Atria ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Immunosuppressive Agents ; Models, Theoretical* ; Pulmonary Artery ; Skin ; Thoracic Cavity ; Thoracotomy ; Tissue Donors ; Transplantation, Heterotopic ; Vena Cava, Superior

BACKGROUND:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. MATERIAL AND METHOD: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. RESULT: Mean age was 68+/-1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 +/-0.81 and mean aortic cross-cramp time was 69.84+/-18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23+/-10.62% preoperatively to 58.14+/-9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27+/-12.51 vs 15.55+/-6.99 days; p<0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58+/-19.56 months). There was no late mortality of cardiac origin. CONCLUSION: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.
Acute Kidney Injury ; Age Factors ; Aged* ; Cause of Death ; Coronary Artery Bypass* ; Coronary Vessels* ; Emergencies ; Follow-Up Studies ; Hospital Mortality ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Sepsis ; Stroke Volume ; Survivors ; Wound Infection

PURPOSE: Non-A, B, C viral hepatitis is the name given to the disease with clinical viral hepatitis, but in which serologic evidence of A, B, C hepatitis has not been found. Little is known about the etiology and clinical features of non-A, B, C viral hepatitis in children. METHODS: A clinical analysis of 45 cases with non-A, B, C viral hepatitis who were admitted to the Department of Pediatrics, Pusan National University Hospital, from January 2001 to June 2004 was carried out retrospectively. Patients who were positive for HBsAg, anti-HAV and anti-HCV and had toxic, metabolic, autoimmune, or neonatal hepatitis were excluded in this study. RESULTS: Among 45 cases of non-A, B, C viral hepatitis, the etiology was unknown in 26 (57.8%), CMV (cytomegalovirus) in 14 (31.1%), EBV (Epstein Barr virus) in 2 (4.4%), HSV (herpes simplex virus) in 2 (4.4%) and RV (rubella virus) in 1 (2.2%). Twenty seven out of 45 (60.0%) patients were under 1 year of age. Sixteen (33.3%) patients had no specific clinical symptoms and were diagnosed incidentally. On physical examination, twenty seven out of 45 patients (60.0%) had no abnormal findings. Forty three out of 45 patients (95.6%) showed classic clinical course of acute viral hepatitis, whereas fulminant hepatitis developed in two patients. Mean serum ALT (alanine aminotransferase) level was 488.7+/-771.9 IU/L. Serum ALT level was normalized in 31 out of 45 patients (81.6%) within 6 months and all patients within 18 months. Aplastic anemia was complicated in a case. CONCLUSION: Although most patients with non-A, B, C viral hepatitis showed a good prognosis, a careful follow-up would be necessary because some of them had a clinical course of chronic hepatitis, fulminant hepatitis and severe complication such as aplastic anemia.
Anemia, Aplastic ; Busan ; Child* ; Follow-Up Studies ; Hepatitis A Antibodies ; Hepatitis B Surface Antigens ; Hepatitis* ; Hepatitis, Chronic ; Herpesvirus 4, Human ; Humans ; Pediatrics ; Physical Examination ; Prognosis ; Retrospective Studies