No abstract available.
Vibrio vulnificus* ; Vibrio*

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

OBJECTIVE: Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. MATERIALS AND METHODS: Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. RESULTS: Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. CONCLUSION: Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.
Aneurysm, Dissecting* ; Angiography, Digital Subtraction ; Diagnosis ; Endovascular Procedures ; Humans ; Prognosis ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery*

Anterior cervical discectomy and fusion (ACDF) has been performed for degenerative and traumatic cervical diseases to improve pain and neurologic symptoms including sensory change and motor weakness. Infection, however, is a rare complication of ACDF, and late infection is even much rarer. We present a case of late Infection from ACDF C4-5 using Biocompatible Osteoconductive Polymer (BOP) after twenty years in the absence of an esophageal perforation, Zenker's diverticulum, or recent surgery or bacteremia. Late infection from ACDF after 20 years is extremely rare in the literature. However, possibility of such a late complication should be appreciated during the follow-up period and surgical resection will be required for proper treatment.
Bacteremia ; Diskectomy* ; Esophageal Perforation ; Follow-Up Studies ; Neurologic Manifestations ; Polymers ; Zenker Diverticulum

OBJECTIVE: This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. METHODS: Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. RESULTS: In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011). CONCLUSION: Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.
Aneurysm ; Brain Ischemia ; Craniotomy ; Demography ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Ischemia ; Reperfusion ; Retrospective Studies ; Risk Factors ; Stroke ; Troleandomycin

PURPOSE: The objective of this study was to evaluate clinical results of dual miniplate fixation for comminuted or periarticular fractures of the hand. MATERIALS AND METHODS: Twenty cases in 18 patients who had comminuted or periarticular fractures of metacarpal or phalangeal bones were treated with dual miniplate fixation from April, 2007 to May, 2009. The mean followed up period was 14.7 months. Our study included comminuted or periarticular fractures which were difficult to keep the fixation by pining or single plating. We evaluated radiologic bony union, angular or rotational deformity, extensor tendon irritaion and total arc of motion. RESULTS: Bony union was achieved successfully after primary dual miniplate fixationin in 12 cases. In 7 cases with a nonunion following previous operative fixation, bony union was obtained by dual miniplate fixation and bone grafting. In one case who had received primary dual plate fixation, nonunion occurred due to massive bone defect. Bony union was obtained by secondary dual plate fixation and bone grafting. Postoperative rotational deformity, angular deformity and irritation symptom were not observed in all cases. Functionally acceptable range of active motion was restored by way of early active motion. CONCLUSION: The dual miniplate fixation is one of the useful method for comminuted metacarpal or phalangeal fractures which cannot obtain firm fixation by other methods.
Bone Transplantation ; Congenital Abnormalities ; Fractures, Comminuted ; Hand ; Humans ; Tendons

A 29-year-old woman in her 8th week of pregnancy was referred to our hospital for swelling in the lower extremities, rapid onset of dyspnea (1 hr) and pre-syncope. Severe right ventricular dysfunction and moderate pulmonary hypertension were detected using 2-dimentional Doppler echocardiography. In addition, left calf vein and proximal thromboses were detected by venous compression ultrasound imaging. After successful thrombolytic treatment, the patient quickly recovered and was discharged from hospital on subcutaneous low-molecular-weight heparin. She delivered a normal, healthy infant at full-term (40 weeks).
Adult ; Dyspnea ; Echocardiography, Doppler ; Female ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary ; Infant ; Lower Extremity ; Pregnancy* ; Pulmonary Embolism* ; Thrombolytic Therapy ; Thrombosis ; Ultrasonography ; Veins ; Venous Thrombosis* ; Ventricular Dysfunction, Right

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.
*Chondromatosis, Synovial/diagnosis/physiopathology/surgery ; Female ; Humans ; Middle Aged ; *Wrist Joint/physiopathology/surgery

Rapidly developed de novo aneurysm is very rare. We present a rapidly developed and ruptured de novo anterior communicating aneurysm 8 days after the rupture of another aneurysm. This de novo aneurysm was not apparent in the initial 3-dimensional computed tomography and digital subtraction angiography. We reviewed the literature and discussed possible mechanisms for the development of this de novo aneurysm.
Aneurysm ; Angiography, Digital Subtraction ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Rupture* ; Subarachnoid Hemorrhage

PURPOSE: The presence of normal fingernail is important for the hand function and cosmetic appearance. We studied the results of the microsurgical reconstruction of the defected fingernail using composite toenail transfer. MATERIALS AND METHODS: From March of 2004 to May of 2009, eleven fingernails were reconstructed using microsurgical composite toenail transfer in 10 patients with a mean age of 27 years (range, 13 to 47 years). There were three thumbs, five index fingers, and three long fingers. Whole fingernail was destructed in three cases and remaining eight cases had partial nail defect. Toenail was grafted from great toe in eight cases and from second toe in three cases. Five cases were harvested as an osteoonychocutaneous flap, two as a endoosteoonychocutaneous flap and four as an onychocutaneous flap. RESULTS: All cases survived without any tissue necrosis. One arterial obstruction had occurred one day after surgery, which was resolved by repeated decompression and reanastomosis of the artery. All fingernails regenerated successfully. According to the rating system including assessment of shape, size and thickness of nail, nail pinch, pain, and patient's satisfaction, ten cases were rated as excellent and one as good. All patient's were satisfied with their hand function and appearance. CONCLUSION: Microsurgical composite toenail transfer can be an acceptable surgical reconstruction for the fingernail defect after trauma, providing satisfactory hand functions and cosmetic appearance.
Arteries ; Cosmetics ; Decompression ; Fingers ; Hand ; Humans ; Nails ; Necrosis ; Thumb ; Toes ; Transplants