BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle/*pathology/radiography/*surgery ; Ankle Fractures/*pathology/radiography/*surgery ; Arthralgia ; Arthroscopy/*methods ; Female ; Fibrosis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: The purpose of this animal study was to perform a histological and histomorphometric analysis in order to elucidate the effect of fibroblast growth factor-2 (FGF-2) on injured periodontal ligament (PDL) and cementum after tooth replantation in dogs. METHODS: The roots of 36 mandibular premolars from six mongrel dogs were used in this study. The roots were randomly divided into three groups: (1) a positive control group (n=12), in which the PDL was retained; (2) a negative control group (n=12), in which the PDL and the cementum between the notches were removed; and (3) an experimental group (n=12), in which the PDL and the cementum between the notches were removed and the roots were soaked in an FGF-2 solution (30 microg/0.1 mL). After treating the root surfaces, the extracted roots were replanted into extraction sockets. The animals were sacrificed four and eight weeks after surgery for histologic and histomorphometric evaluation. RESULTS: At four and eight weeks, normal PDLs covered the roots in the positive control group. In the negative control group, most replanted roots showed signs of replacement resorption. In the experimental group, new PDL-like tissue and cementum-like tissue were observed to partially occupy the region between the root surfaces and the newly formed bone. Histomorphometric analysis showed that the mean length of the newly formed cementum-like tissue on the roots treated with FGF-2 was significantly greater than that of the tissue on the roots in the negative control group (four weeks, P=0.008; eight weeks, P=0.042). However, no significant differences were observed between the roots treated with FGF-2 and the negative control roots with respect to newly formed PDL-like tissue. CONCLUSIONS: The results of this study suggest that use of FGF-2 on injured root surfaces promotes cementogenesis after tooth replacement in dogs.
Animals ; Bicuspid ; Cementogenesis ; Dental Cementum* ; Dogs* ; Fibroblast Growth Factor 2 ; Fibroblast Growth Factors* ; Periodontal Ligament* ; Periodontium ; Regeneration ; Tooth ; Tooth Replantation*

In order to observe the change of the clinical results after Microvascular Decompression(MVD), we followed up 261 cases with hemifacial spasm(HFS). The patients were operated between Nov. 1985 and Aug. 1994. The length of observation had been more than 6 months in all cases. The mean age of the patients was 47.0 years old and the mean duration of symptom was 8.2 years. Female constitutes 82.8% of the total an right side was involved in 52.1%. The most common offender was the anterior inferior cerebellar artery (51.0%), and 33% involved multiple vessels. The most common offender was the anterior inferior cerebellar artery (51.0%), and 33% involved multiple vessels. The postoperative complications occurred in 84 cases, 4 of which were permanent. However, there were no mortalities. Among the 226 cases, which were followed up for more than 6 months after the MVD, the final clinical results of 187 cases were excellent, the success rate was 91.7%, and the patients' satisfaction rate was 96.1%. The rate of excellence was 61.1% at POD 7th and 82.7% at final, respectively. The delayed resolution of the HFS during follow-up comprised 37.4% of the completely resolved cases. According to the above results, the clinical status of HFS after MVD continuously changes, therefore follow-up observation after MVD is needed to evaluate the operative results, especially in the delayed resolved cases.
Arteries ; Criminals ; Female ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery* ; Mortality ; Postoperative Complications ; Prospective Studies*

BACKGROUND: Hypothermia following the induction of anesthesia is caused by core to peripheral redistribution of body heat. It has been reported that propofol causes more severe hypothermia than sevoflurane by inhibiting thermoregulatory vasoconstriction during surgical procedures. Therefore, we evaluated the induction and maintenance of anesthesia with intravenous propofol to determine if it causes more core hypothermia than inhaled sevoflurane. METHODS: Forty-five patients who underwent hysterectomy were divided into two groups randomly, a propofol-remifentanil (PR) anesthesia group and a sevoflurane-remifentanil (SR) anesthesia group. Each group was subjected to anesthetic induction with either 1.5 mg/kg propofol or inhalation of 5% sevoflurane, respectively. Anesthesia in the former group was maintained with propofol while it was maintained with sevoflurane in the latter group. Specifically, 6-10 mg/kg/hr propofol, 3 L/min medical air, 2 L/min O2, and 0.25 mg/kg/hr remifentanil were used in the PR group for maintenance, while 1.5 vol% sevoflurane, 3 L/min medical air, 2 L/min O2 and 0.25 mg/kg/hr remifentanil were used for maintenance in the SR group. We measured the core temperature 8 times, prior to induction and 10, 20, 30, 45, 60, 75 and 90 minutes after induction. RESULTS: Core temperatures decreased in both the PR and SR group during surgical operation, but there was no significant difference between the two groups. CONCLUSIONS: Anesthesia induced and maintained by propofol did not cause a greater degree of hypothermia than sevoflurane.
Anesthesia ; Hot Temperature ; Humans ; Hypothermia ; Hysterectomy ; Inhalation ; Methyl Ethers ; Piperidines ; Propofol ; Vasoconstriction

A 46-year-old woman underwent a right thyroidectomy with left neck dissection under general anesthesia. The operation was performed successfully for over the course of 3 hours 30 minutes. After extubation, the patient was transferred to post-anesthetic care unit (PACU). After 10 minutes, dyspnea, chest discomfort, desaturation was suddenly occurred. Intubation was performed in PACU. The emergency chest X-ray revealed a right pneumothorax, and the patient was treated by chest tube insertion. The patient was improved and was discharged uneventfully from hospital 8 days later.
Anesthesia, General ; Chest Tubes ; Dyspnea ; Emergencies ; Female ; Humans ; Intubation ; Middle Aged ; Neck ; Neck Dissection ; Pneumothorax ; Thorax ; Thyroidectomy

The significance of intraoperative electrophysiologic monitoring during microvascular decompression was evaluated prospectively in 261 patients with the hemifacial spasm from 1985 to 1995. The patients were divided into a monitored group and a non-monitored group. Identification of the offending vessels was facilitated by the monitoring during the surgical procedure and the complication rate of the monitored group was significantly lower than that of the non-monitored group (p< 0.05). In addition, the abnormal muscle response continued to improve during the follow-up period, thus the electrophysiological status of the hemifacial spasm after the microvascular decompression improved significantly with time (p< 0.05). In conclusion, intraoperative monitoring is useful for identifying the exact offender among multiple vessels, and lowering the complication rate of the microvascular decompression for the hemifacial spasm.
Adult ; *Decompression, Surgical ; *Facial Muscles ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; *Monitoring, Intraoperative ; Spasm/physiopathology/*surgery

We report on an unusual case with infiltrating extradural spinal angiolipoma. Most spinal angiolipomas involve the thoracic spine and infiltrating ones are also located mainly at the thoracic levels rather than lumbar lesion. In particular, there are few cases of lumbar extradural infiltrating type spinal angiolipoma. One case is that of a 52-year-old female with infiltrating extradural spinal angiolipoma involving lumbar 4 (L4) vertebra, who underwent a L4-5 laminectomy and surgical removal of the tumor. We achieved satisfactory results with surgical treatment of the patient. Spinal angiolipoma has a benign course with a good postoperative outcome.
Angiolipoma* ; Female ; Humans ; Laminectomy ; Middle Aged ; Spine*

BACKGROUND: Strains of methicillin-resistant Staphylococcus aureus (MRSA) have emerged as important pathogens affecting primarily hospitalized patients. However, some investigators reported an increase in the frequency of community-acquired MRSA infections among persons who did not appear to have any of the recognized risk factors associated with nosocomial acquisition of MRSA. We designed this study to assess the proportion of MRSA in S. aureus bacteremia in the community and risk factors for MRSA bacteremia. METHODS: We reviewed the medical records of 334 cases during 1991~1992 and 1996~1997 and 93 cases in the emergency room of the Seoul National University Hospital during 1993~1995, in which S. aureus was isolated from blood samples. We retrospectively analyzed 210 cases (154 and 56 cases, respectively), which satisfied the definition of clinically significant bacteremia and of which medical records were available. RESULTS: Of 154 bacteremia cases reviewed, 32 (20.8%) were community-acquired and 122 (79.2%) were nosocomial during 1991~1992 and 1996~1997. MRSA occupied 18.8% (6 of 32) in community- acquired S. aureus bacteremia and 44.3% (54 of 122) in our hospital cases. We could not find a statistically significant increase in the rate of methicillin resistance in the community and our hospital. All of 15 cases classified as community-acquired MRSA bacteremia during 1991~1997 had more than one predisposing risk factor for MRSA infection. Nosocomial MRSA bacteremia were more frequently observed among the patients treated in the intensive care unit. (32.4% vs 10.2%, P=0.001). CONCLUSION: MRSA bacteremia occupied 18.8% of community-acquired S. aureus bacteremia. All cases with community-acquired MRSA bacteremia had more than one predisposing risk factor for MRSA infection. We did not observe a statistically significant increase in the proportion of MRSA bacteremia in S. aureus bacteremia.
Bacteremia* ; Emergency Service, Hospital ; Epidemiology* ; Humans ; Intensive Care Units ; Medical Records ; Methicillin Resistance* ; Methicillin* ; Methicillin-Resistant Staphylococcus aureus ; Research Personnel ; Retrospective Studies ; Risk Factors* ; Seoul ; Staphylococcus aureus* ; Staphylococcus*

PURPOSE: To investigate the measured values of the talus in Koreans. MATERIALS AND METHODS: We measured 88 tali from 44 cadavers that have been donated between December 2012 and December 2015. Of the cadavers, 27 were male and 17 were female. Their mean age was 73 years. The length and width of the talus were measured using a digital goniometer and vernier caliper. RESULTS: The values of cadaveric measurement, mean maximal width and length, width and length of the dome anterior, width and length of the posterior facet, height and length of the trochlear medial facet, and height and length of the trochlear lateral facet were 43.6±2.6 mm, 56.5±3.3 mm, 32.5±2.0 mm, 42.2±2.7 mm, 22.2±2.2 mm, 34.7±2.0 mm, 15.3±1.3 mm, 33.3±2.9 mm, 25.3±3.3 mm, and 30.8±2.4 mm for men and 38.9±1.6 mm, 53.6±2.4 mm, 27.9±2.1 mm, 37.4±3.2 mm, 20.6±0.8 mm, 31.9±1.2 mm, 13.6±2.6 mm, 28.4±2.5mm, 24.9±2.1 mm, and 28.9µ1.4 mm for women, respectively. The size of the talus showed an accuracy of 86% when anteroposterior diameter was greater than 59 mm. A difference in the size of the right and left talus was not observed. The mean inclination and declination angles were 24.4°±4.2° and 28.2°±5.4° for men, and 24.6°±3.6° and 24.7°±6.7° for women (p=0.980, p=0.018), respectively, at least 15°, which showed a big difference for every object up to 37°. CONCLUSION: This paper, to the best of our knowledge, is the first study to measure the talus in Koreans. There were differences by gender and ethnicity in the in measured talus values. The measurements were smaller than European-Americans and greater than Japanese.
Asian Continental Ancestry Group ; Cadaver* ; Female ; Humans ; Male ; Talus*

The authors present a case of post-traumatic tension pneumocephalus of delayed onset. A 23-year-old man fell down and was admitted to our hospital with initial diagnosis of basal skull fracture associated with small amounts of pneumocephalus on brain computerized tomography(CT). At admission, the consciousness was alert without focal neurological deficit. During conservative therapy, headache was slowly progressive and consciousness became drowsy on 13th day after admission. The brain follow-up CT showed huge low air density lesion in the right frontal area. We performed unilateral subfrontal craniotomy with duroplasty for removal of air and dural repair with galea aponeurotica and abdominal fat. Postoperatively, the condition was recovered.
Abdominal Fat ; Brain ; Consciousness ; Craniocerebral Trauma ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Headache ; Humans ; Pneumocephalus* ; Skull Fractures ; Young Adult