In the orthopedic Department of Jeonbug National University Hospital, twenty-five open tibial shaft fractures were reviewed and analyzed with osteomedullography and bone scanning with radioactive isotopes from June 1981 to October 1983. The results are as follows. 1. The cases of injury were mostly traffic accident(70.8%) and majority was found between second decade and third decade. Males were 11 times more frequent than females. 2. In the shape and location of fractures, comminuted fracture(60%) was most common, and fracture of middle one third(48%), lower one third(28%) were in order. 3. In the open tibial fractures, Grade I. of soft tissue injury was most frequent(64%). As inthe plate fixation was required, we should it placed atypically on the posterior surface of the tibia. 4. In the osteomedullography at 3 months after treatment, the rate of positive finding was 80 and intraosseous crossing vein(Kaski sign 1) was observed most frequently. 5. In the profile of the bone scanning with radioactive isotopes, the rate of single-peak uptake was 76% and twin-peak uptake was 24%. 6. In the negative Osteomedullogram and twin-peak uptake on the profile of the bone scanning, bone graft was necessary. 7. In the case of difficult diagnosis for union process of tibia fracture, osteomedullography and bone scanning with radioactive isotopes were considered useful method of early diagnosis.
Diagnosis ; Early Diagnosis ; Female ; Fractures, Comminuted ; Fractures, Open ; Humans ; Jeollabuk-do ; Male ; Methods ; Orthopedics ; Radioisotopes ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Transplants

PURPOSE: We wanted to analyze the causes of revision and the clinical and radiographic results after revision total knee arthroplasty. MATERIALS AND METHODS: Thirty-eight knees in 34 patients underwent revision total knee arthroplasty using the PFC(R) Sigma revision system between March 1999 and May 2005. The average patient age was 71.2 years, and the average follow-up period was 6 years 7 months (range: 4 years~10 years 2 months). We evaluated the time interval between the primary and revision arthroplasty and the causes of revision. The clinical outcomes were assessed using the knee score and the functional score of the Knee Society Scoring system (KSS system), and the radiographic measurements were assessed using the roentgenographic method of the American Knee Society. RESULTS: The mean interval between primary and revision arthroplasty was 6 years 3 months. The causes of revision included 25 cases of aseptic loosening and osteolysis, 7 cases of infection, 3 cases of joint stiffness and 3 cases of polyethylene problems. At the follow up, the mean preoperative knee and functional scores improved from 45.1 points to 84.5 and 37.2 to 78.2, respectively. Radiographycally, the average femorotibial angle was corrected from 2.2degrees in valgus to 6.5degrees. The radiolucency score was below 4 in all the cases. The complications after revision arthroplasty were 2 cases of superficial infection and 1 case of wound dehiscence with a skin defect. CONCLUSION: The main causes of revision arthroplasty were aseptic loosening and osteolysis. Satisfactory results were obtained using the posterior cruciate ligament and substituting the PFC(R) Sigma knee system with appropriately selected metal augmentation and an allograft. This study showed favorable results on long term follow-up.
Arthroplasty ; Follow-Up Studies ; Humans ; Joints ; Knee ; Osteolysis ; Polyethylene ; Posterior Cruciate Ligament ; Skin ; Transplantation, Homologous

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.
Barotrauma ; Catheters ; Constriction, Pathologic ; Emergencies ; Epidural Space ; Female ; Hemiplegia ; Humans ; Intervertebral Disc ; Leg ; Lower Extremity* ; Sensation ; Spinal Stenosis ; Young Adult

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.
Adult ; Ambulatory Care ; Daegu ; Direct Service Costs ; Hospitals, General ; Humans ; Hypertension ; Insurance ; Insurance, Health ; Prescriptions* ; Public Health

OBJECTIVES: To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. METHODS: The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. RESUJLTS: The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I,IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses, 453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). CONCLUSIONS: The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.
Adult ; Ambulatory Care ; Daegu ; Direct Service Costs ; Hospitals, General ; Humans ; Hypertension ; Insurance ; Insurance, Health ; Prescriptions* ; Public Health

PURPOSE: This study investigated the effects of early enteral feeding on the morbidities of extremely low birth weight infants (ELBWI) weighing less than 1,000 g. METHODS: We conducted a retrospective review of the medical records of sixty one ELBWI who were admitted to the neonatal intensive care unit of Inje University Busan Paik Hospital from January 2007 to October 2009. ELBWI were divided into two groups; the control group included ELBWI from January 2007 to March 2008, for whom enteral feeding was started beyond 3 days and the early feeding group included ELBWI from April 2008 to October 2009, for whom enteral feeding was started within 3 days. RESULTS: Gestational age and birth weight did not differ between the two groups. In the early feeding group, start day of enteral feeding (control group vs. early feeding group; 7+/-2days vs. 2+/-1days), time to achieve full enteral feeding (68+/-6 days vs. 22+/-2 days), and the duration of parenteral nutrition (58+/-6 days vs. 22+/-2 days) were significantly shorter, and weight gain at postnatal day 28 was significantly higher than that of the control group (P<0.001). No differences were observed in the incidence of sepsis and necrotizing enterocolitis and duration of hospitalization; however, the incidence of total parenteral nutrition induced cholestasis (44% vs. 7%) and bronchopulmonary dysplsia (78% vs. 24%) was significantly lower in the early feeding group. CONCLUSION: Early enteral feeding in ELBWI shortened the time to achieve full enteral feeding, improved weight gain, and decreased the incidence of brochopulmonay dysplasia and cholestasis.
Birth Weight ; Cholestasis ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Retrospective Studies ; Sepsis ; Weight Gain

PURPOSE: To compare the performance of a fixed bearing with a PFC Sigma with that of a rotating platform in a total knee arthroplasty performed on patients with a moderate to severe varus deformity. MATERIALS AND METHODS: Among the patients who had received a total knee arthroplasty with either a PFC sigma fixed bearing or a rotating platform between October 1998 to June 2002, 77 cases (53 patients) with a > 15degrees varus deformity were examined. The surgery time and the clinical ratings and the radiographic images for each patient were investigated. RESULTS: There were no significant differences in the knee score, functional score, activity level, or radiological findings. There were seven cases where friction sounds were produced from the insertions in the rotating platform whilst walking and there were three cases of lateral instability. CONCLUSION: The PFC sigma fixed bearing was more effective for stabilizing the knees with a moderate to severe varus deformity because the rotating platform had a friction sound from the insertions while walking and lateral instability.
Arthroplasty* ; Congenital Abnormalities* ; Friction ; Humans ; Knee* ; Walking

PURPOSE: To evaluate the effect of posterior cruciate ligament retaining total knee arthroplasty on its clinical results in patients with varus deformity. MATERIALS AND METHODS: We analyzed clinical and radiologic results of the 61 cases (39 patients) with varus deformity more than 15 degrees retrospectively. The average follow up period was 6.1 years (range, 5~8 years old). The cases were divided into posterior cruciate ligament retaining group A (42 cases) and substituted group B (19 cases). RESULTS: There was no statistically significant difference between two groups in Knee Society knee score (A group: 88.1, B group: 88.9), functional score (A group: 79.3, B group: 75.6) activity level (A group: 67.5, B group: 62.5), flexion contracture (A group: 4.5 degree, B group: 4.9 degree), tibiofemoral angle (A group: 4.7 degree, B group: 5.2 degree) and roentgenographic findings. Patients with PCL retaining knees showed significantly increased activity levels in going up and down stairs, and walking. CONCLUSION: It is considered that the preservation of the posterior cruciate ligament is better than the substitution of the ligament if technical problems are solved.
Arthroplasty* ; Congenital Abnormalities* ; Contracture ; Follow-Up Studies ; Humans ; Knee* ; Ligaments ; Posterior Cruciate Ligament ; Retrospective Studies ; Walking

PURPOSE: To analyze the clinical and roentgenographic results of rheumatoid arthritis and osteoarthritis after cemented total knee arthroplasty with posterior cruciate retention. MATERIALS AND METHODS: Since 1989, 53 cases of rheumatoid arthritis and 454 cases of osteoarthritis were followed up for average 7.3 years(range 5-14 years) after cemented total knee arthroplasty with posterior cruciate retention. RESULTS: There was no statistically difference in KSS knee score(A: 88.5, B: 92.2), functional score(A: 73.2, B: 79.3), activity level(A: 76, B: 80), flexion contracture(A: 4.5 degree, B: 4.3 degree), tibiofemoral angle(A: 4.8 degree, B: 4.7 degree) and roentgenographic findings. There were hyperextension of 4 cases in group A and 3 cases in group B, but instability was not found. CONCLUSION: There was no significant difference in clinical and radiological results between the osteoarthritic and rheumatoid arthritic group after cemented TKR with PCL retention. Therefore, cemented TKR with PCL retention could be used as a valuable method in treating rheumatoid arthritis.

We report a case of a ruptured triple hormone-secreting adrenal mass with hyperaldosteronism, hypercortisolism, and elevated normetanephrine levels, diagnosed as adrenal cortical carcinoma (ACC) by histology. A 53-year-old male patient who initially presented with abdominal pain was referred to our hospital for angiocoagulation of an adrenal mass rupture. Abdominal computed tomography revealed a heterogeneous 19×11×15 cm right adrenal mass with invasion into the right lobe of the liver, inferior vena cava, retrocaval lymph nodes, and aortocaval lymph nodes. Angiocoagulation was performed. Laboratory evaluation revealed excess cortisol via a positive 1-mg overnight dexamethasone suppression test, primary hyperaldosteronism via a positive saline infusion test, and plasma normetanephrine levels three times higher than normal. An adrenal mass biopsy was performed for pathological confirmation to commence palliative chemotherapy because surgical management was not deemed appropriate considering the extent of the tumor. Pathological examination revealed stage T4N1M1 ACC. The patient started the first cycle of adjuvant mitotane therapy along with adjuvant treatment with doxorubicin, cisplatin, and etoposide, and was discharged. Clinical cases of dual cortisol- and aldosterone-secreting ACCs or ACCs presenting as pheochromocytomas have occasionally been reported; however, both are rare. Moreover, to the best of our knowledge, a triple hormone-secreting ACC has not yet been reported. Here, we report a rare case and its management. This case report underscores the necessity of performing comprehensive clinical and biochemical hormone evaluations in patients with adrenal masses because ACC can present with multiple hormone elevations.