Fibular fractures that begin proximal to the tibial plafond are assumed to include an injury of the syndesmosis. Many surgeons have treated this injuries by rigidly repairing the medial and lateral malleoli with trans-syndesmotic fixation. However, recently, some demonstrated that a trans-syndesmotic screw places biomechanical restrictions on the tibiotalar joint and is not required to maintain the integrity of the distal tibiofibular joint in cadava models. Thirty eight patients of ankle fracture with syndesmotic injury treated at Sun General Hospital from January 1989 to June 1994 week analyzed in clinical and radiologic aspect. The results obtained from this study were as followings. 1. If rigid anatomic medial and lateral joint fixation was obtained, syndesmotic screw fixation was not required to maintain the integrity of the syndesmotic. 2. Repairting the deltoid ligament did not enhance treatment results when fibular fracture and syndesmotic had been fixed anatomically. Therefore, we believe that syndesmotic screw fixation was indicated only when medial and lateral stabilization could not be achieved adequately.
Ankle Fractures ; Ankle Injuries ; Ankle ; Hospitals, General ; Humans ; Joints ; Ligaments ; Solar System ; Surgeons

It is been known that the deltoid ligament of the ankle joint plays an important role in the stabiliy of the ankle joint. In cases of deltoid ligament rupture, associated with lateral malleolar fractures, cannot be maintained the integrity of the mortise and the stability of the talus. Controversy remains about the treatment of deltoid ligament injuries. Many authors advocate an operative repair for deltoid ligament ruptures for optimal reduction of lateral malleolar fracture. However, according to recent cadaveric studies and many satisfactory results of clinical studies, excellent results have been reported regarding the ankle joint stability by anatomical reduction of the lateral structure, but only without surgical repair of the medial structure. Fourteen patients with lateral malleolar fractures with associated deltoid ligament injuries treated at Sun General Hospital between January 1990 and June 1995. There were examined clinically and radiologically. We concluded that deltoid ligament repairs should be considered unnecessary as long as fibular fracture are stabilized anatomically with normal medial joint space. However, in cases with higher fracture levels of lateral malleolus, associated with syndesmotic injury, we recommend syndesmotic screw fixation or deltoid ligament repair.
Ankle ; Ankle Injuries ; Ankle Joint ; Cadaver ; Fibula* ; Hospitals, General ; Humans ; Joints ; Ligaments* ; Rupture ; Solar System ; Talus

OBJECTIVES: This study was designed to investigate the characteristics of personality changes and emotional distress using the Personality Assessment Inventory (PAI) in patients with traumatic brain injury(TBI), divided into mild (MTBI) and severe (STBI) groups according to the severity of injury. METHODS: The subjects were consisted of 25 patients with MTBI, 25 patients with STBI, and 25 normal controls. They were interviewed with the PAI. The data were analyzed by chi-square test, analysis of variance and Tukey test. RESULTS: The results were the followings. First, Negative Impression in validity scales was elevated above cutoff point(T score 70) in both MTBI and STBI groups. Second, the clinical scales of which scores elevated above the cutoff point were Somatic Complaints, Anxiety, Anxiety-Related Disorders, epression, and Schizophrenia in the MTBI, and Somatic Complaints and Depression in the STBI. Third, the clinical subscales above the cutoff point were Conversion, Somatization, Health Concerns, Affective Anxiety, Physiological Anxiety, Traumatic Stress, Cognitive Depression, Affective Depression, Physiological Depression, Thought Disorder, and Affective Instability in the MTBI, and Health Concerns, Cognitive Depression, Affective Depression, and Physiological Depression in the STBI. Fourth, Suicide Ideation in treatment scales was the only scale above the cutoff point in the MTBI and the others of the treatment and interpersonal scales in the MTBI and all of these scales of the STBI were not elevated above the cutoff point. Fifth, the scales of which scores showed significant difference between the MTBI and the STBI were Somatic Complaints, Anxiety, Depression, and Suicide Ideation, the subscales were Conversion, Somatization, Health Concerns, Affective Anxiety, Physiological Anxiety, Physiological Depression, and Psychotic Experiences. CONCLUSION: These results suggest that the patients with MTBI had more somatic and anxiety symptoms, depressed mood, and suicidal ideation than the patients with STBI. These characteristics are generally consistent with clinical observation and findings from previous studies of the patients with TBI, and the PAI seems to be a beneficial adjunctive assessment tool for the evaluation of patients with traumatic brain injury.
Anxiety ; Brain ; Brain Injuries* ; Depression ; Humans ; Personality Assessment* ; Schizophrenia ; Suicidal Ideation ; Suicide ; Weights and Measures

OBJECTIVES: This study examined the characteristics and differences of PAI(Personality Assessment Inventory) profile between compensation-seeking(CS) and treatment-seeking(TS) patients with traumatic brain injury(TBI) and assessed the clinical meaning of the characteristics and differences of profiles between the two groups. METHODS: 36 TBI patients who visited the Wonkwang University Hospital were selected. The patients were categorized as compensation-seeking TBI patients(n=22) and treatment-seeking TBI patients(n=14). The PAI scales and subscales were used to compare differences between two groups. t-verification for each variable and comparison analysis were performed. RESULTS: In validity scales, CS group showed significantly higher NIM scores and lower PIM scores than TS groups. In full scales, CS group showed significantly higher SOM, ANX, ARD, DEP, and SCZ scores than TS group. In subscales, CS group showed significantly higher SOM-S, ANX-A, ARD-P, DEP(-C, A, P), (MAN-I), PAR-H, SCZ(-T, P), BOR(-A, N), and ANT-S scores than TS groups. In supplementary scales, CS group showed significantly higher SUI, NON and AGG-P, and lower RXR scores than TS group. CONCLUSIONS: There were significant differences in PAI scales with validity scales, some full and subscales according to compensation seeking status in TBI patients. The CS patients tended to exaggerate their symptoms on PAI, and showed higher scores representing somatic preoccupation and emotional distress. These results show the usefulness of PAI in reflecting the significant psychological differences between two groups.
Brain ; Brain Injuries* ; Compensation and Redress ; Humans ; Personality Assessment* ; Weights and Measures

PURPOSE: The purpose of this study was to evaluate the clinical benefits of preoperative percutaneous transhepatic drainage (PTGBD), especially regarding morbidity and mortality, in patients aged 60 or older with acute cholecystitis. METHODS: A retrospective study was done on a series of elderly patients (>60 years old; n=132) who had been diagnosed between January 2007 and December 2009 as having acute cholecystitis. The patients were divided into 4 groups; cases in which only laparoscopic cholecystectomy (LC) was done (Group 1, n=84), cases in which LC was done after preoperative PTGBD (Group 2, n=15), cases in which only open cholecystectomy was done (Group 3, n=23), and cases in which open cholecystectomy was done after preoperative PTGBD (Group 4, n=10). We analyzed between group differences in surgical outcomes including periods of postoperative fast and postoperative hospital stay, OP. morbidity, and open conversion rate. RESULTS: Patients in Group 1 had fewer underlying medical problems and lower ASA scores than patients in groups 2, 3, or 4 (p<0.05). Mean operating time in Group 2 (113.66+/-107.5 min) was significantly longer than in group 1 (72.02.9+/-34.2 min) (p<0.05) and the open conversion rate was higher (8.33% vs 26.67%). But, blood loss (ml) and OP time in Group 2 were lower than in Group 3 or 4 (p<0.001). Postoperative recovery progression (periods of postoperative fasting and length of postoperative hospital stay) of Group 2 were better than in groups 3 or 4 (p<0.001). CONCLUSION: Pre-operative PTGBD procedures in elderly patients with acute cholecystitis is a good clinical option as a pretreatment to a cholecystitis operation.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Fasting ; Gallbladder ; Humans ; Length of Stay ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.
Female ; Humans ; Korea ; Prospective Studies ; Psychometrics* ; Surveys and Questionnaires* ; Translations ; Urinary Bladder ; Urinary Incontinence* ; Urination