Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

BACKGROUND: Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. METHODS: A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. RESULTS: Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). CONCLUSIONS: This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
Emergency Service, Hospital ; Factor VIIa* ; Female ; Humans ; Maternal Death ; Maternal Mortality ; Medical Records ; Organ Dysfunction Scores ; Postpartum Hemorrhage* ; Postpartum Period* ; Prognosis ; Recombinant Proteins ; Retrospective Studies

To determine effects of the direction of the rotational work shifting on the circadian rhythm and adaptation of physiological and psychological components were investigated with nursing students. Two groups of seven volunteers participated as experimental subjects, and eight nursing students participated as a control group. The directions of rotation work shift were as follows : CW(clockwise)-shift system rotation in the direction of day shift(3 lays), evening shift(3days), off duty(1day) and night shift(5days). and CCW(counterclockwise)-shift system rotation in the reverse direction. Urinary free cortisol and 17-hydroxycorticoster oids in the urine were measured by the solid-phase radioimmunoassay and the colorimetry methods, re spectively. Plasma melatonin was measured by radioimmunoassay. The urinary free cotisol rhythm changed to ir-regular on the evening and night shift in the CCW shift system, whereas the rhythm seems to adapt on night shift in the CW shift system. The daily rhythms of urinary 17-OHCS indicate that they are well synchronized to shift work. These results show that the rotation of shift in the CW direction is more acceptable in terms of the adaptation of hormonal rhythms. These results indicate that the CCW rotation of shift work makes it more difficult for the workers to adapt on a physiological level, and has many more negative effects on nurses when compared with the CW rotation. Thus, a clockwise rotating shift systern seems to be more desirable for the optimal health and performance of nurses.
Circadian Rhythm* ; Colorimetry ; Humans ; Hydrocortisone* ; Melatonin ; Plasma ; Radioimmunoassay ; Students, Nursing ; Volunteers

The clinical entity of Dysplasia Epiphyseal Multiplex was first descrihed by Fairbank in 1935, characterized by the disturbance of endochondral ossification in hoth epiphyseal centers and regions of physeal growth. It manifests itself radiologically as late appearance and mottling of the ossification centers and clinically as short stature, stubby digits and painful stiffness of multiple joints. It is typically transmitted as an autosomal dominant trait though recessive forms have been described. The spine is normal apart from a mild increased lumbar lordosis. Many patients are referred to an orthopaedic surgeon for bilateral Perthes disease, as was one of the authors cases. This Paper reports four cases of multiple epiphyseal dysplasia which affected one family.
Animals ; Hip ; Humans ; Joints ; Knee ; Legg-Calve-Perthes Disease ; Lordosis ; Osteochondrodysplasias* ; Spine

The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
Adult ; Arthritis, Rheumatoid* ; Aspergillus fumigatus ; Bacillus ; Biopsy, Needle ; Chest Pain ; Cough ; Drainage ; Dyspnea ; Eosinophilia* ; Eosinophils ; Fever ; Fistula* ; Fungi ; Humans ; Hydropneumothorax ; Lung* ; Necrosis ; Needles ; Pleural Cavity ; Pneumothorax ; Pseudomonas ; Thoracotomy ; Thorax

The present study evaluated of regeneration effect of platelet rich plasma on the treatment of classII furcation involvement, with allograft in humans. The control was treated without bioabsorbable membrane, and the test was treated with bioabsorbable membrane. Pocket depth, clinical attachment level, and gingival recession were measured at baseline, postoperative 3, 6months. Both groups were statistically analyzed by Wilcoxon signed Ranks Test & Mann-whitney Test using SPSS program (5% significance level). The results were as follows: 1. The change of pocket depth and clinical attachment level in both groups was decreased significantly at 3, 6months. (p<0.05) 2. The change of gingival recession in both groups was increased significantly at 3, 6months than at baseline. (p<0.05) 3. The change of pocket depth and clinical attachment level in both groups was increased significantly at 3, 6months, but there were no statistically or clinically significant differences with both groups. 4. The change of gingival recession in both groups was increased significantly at 3, 6months, but there were no statistically or clinically significant differences with both groups. 5. The significant reduction of the pocket depth and clinical attachment level exhibited marked changes at 3 months in both groups. In conclusion, the results of this study suggest that there are no statistically or clinically significant differences between with and without bioabsorbable membrane on treatment of classII furcations using allograft and PRP
Allografts* ; Gingival Recession ; Humans ; Membranes* ; Platelet-Rich Plasma ; Regeneration

No abstract available.
Cytomegalovirus* ; DNA* ; Glomerulonephritis* ; Polymerase Chain Reaction*

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

Central retinal vein occlusion(CRVO) and branch retinal vein occlusion(BRVO) are the most common retinal vascular diseases. Althouht the pathogenesis of these two dieseases are different, the clinical features are similiar. In this paper, we studied on several factors such as sex, age, laterality, refractive error, intraocular pressure(IOP) and, systemic diseases(56 eyes of CRVO group and 128 eyes of BRVO group). In BRVO hroup, female, above 50 years old, bilaterality and hyperopia(above +3.0D) are more frequent than in CRVO group. In CRVO group, high IOP and below 40 years old are more frequent than in BRVO group. The hing incidence of female in BRVO group(P=0.034) and the high incidence of high IOP in CRVO group(P=0.011) are statistically significant. Diabetes melitus, glucose intolerance, tuberculosis, and syphilis are more frequently associated in CRVO group than in BRVO group, whereas hypertension and heart disease are more frequently associated in BRVO group. An abnormal level in CRP, VDRL and PTT are higher in CRVO group than in BRVO. On the other hand, the incidences of abnormal lipid profile, Hb A2 fraction and RA are higher in BRVO group than in CRVO. In cases of CRVO, the incidence of hypertension is higher in patients of 50 years old or older than in patients do 49 years old or younger, In cases of BRVO, the incidence of heart disease in patients of 50 years old or older is higher than in patients of 49 years old or younger, which both diseases are statistically significant(P<0.05).
Adult ; Female ; Glucose Intolerance ; Hand ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Middle Aged ; Refractive Errors ; Retinal Vein* ; Retinaldehyde* ; Risk Factors* ; Syphilis ; Tuberculosis ; Vascular Diseases

A massive pulmonary embolism occurring during surgery is a fatal complication. Therefore, early detection and subsequent treatment of pulmonary emboli are important clinical challenges. In this report, an acute pulmonary embolism associated with cardiac arrest occurred during the surgical reduction of a femur fracture. It was diagnosed by echocardiography and treated with urokinase successfully. Therefore, we recommend the use of urokinase for the treatment of a intraoperative massive pulmonary embolism.
Echocardiography ; Femur* ; Heart Arrest ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator*