BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

BACKGROUND: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. METHODS: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg + lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. RESULTS: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 +/- 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 +/- 3.1 points (p<0.001). CONCLUSIONS: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
Bursitis* ; Follow-Up Studies ; Humans ; Joints ; Lidocaine ; Motion Therapy, Continuous Passive ; Prospective Studies ; Range of Motion, Articular ; Rehabilitation ; Shoulder ; Visual Analog Scale

The methods of treatment of spondylolisthesis range from posterior fusion to instrumentation, and circumferential fusion. Combined anterior and posterior fusion with instrumentation had been carried out in one or two stages and satisfactory results were obtained in nighteen cases with follow-up period of one year to four years at department of orthopedic surgery of Ewha Womans University Hospital from 1987 to 1991. The results were as follows: 1. Of 19 patients, 7 patients were male and 12 patients were famale. 2. The isthmic type was 12 cases (63.1%) and the 5th lumbar vertebral involvement is common (12 cases, 63.1%). 3. The operative treatment was as follows: Posterior fusion with instrumentation was 8 cases, and anterior fusion with instrumentation was 11 cases. 4. The combined anterior and posterior fusion with instrumentation had been carried out in one stage operation at 8 cases, and two stage operation was done at 11 cases. 5. The average operation time was 3.0 hrs in one stage operation, 3.1 hrs in two stage operation, and the average amount of blood loss was 22cc/Kg in one stage, 17cc/Kg in two stage. 6. The satisfactory results were obtained in 19 cases, but there was no specific difference between one stage and two stage operation.
Female ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Spondylolisthesis

BACKGROUND: Hydromorphone has an intermediate lipid solubility range that falls between morphine and fentanyl. Lipophilic activity during opioid epidural administration is important in relation to both the side effects and analgesic efficacy. The purpose of this study was to compare epidural hydromorphone and fentanyl when concomitantly infused with bupivacaine in patients undergoing a thoracotomy. METHODS: Seventy-seven thoracotomy patients, with patient-controlled epidural analgesia (PCEA), were blindly allocated into two groups [group F (n = 34); 0.1% bupivacaine and fentanyl 5microgram/ml, group H (n = 34); 0.1% bupivacaine and hydromorphone 16microgram/ml)]. The basal PCEA rate and demand dose were 4 ml/hr and 3 ml, respectively. The visual analogue scale (VAS) for pain, and pruritus, sedation and nausea were measured at 6, 12 and 24 hours after the operation. RESULTS: There were no significant differences in the VAS pain scores and the incidences of pruritus, nausea and sedation between the two groups. The total infused volume after 24 hours was lower in H compared to that of F group (P < 0.05). CONCLUSIONS: We conclude that epidural hydromorphone or fentanyl administration has a similar analgesic efficacy and shows similar incidences of side effects, when concomitantly infused with bupivacaine, in the management of acute pain following a thoracotomy.
Acute Pain ; Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Bupivacaine ; Fentanyl ; Humans ; Hydromorphone ; Incidence ; Morphine ; Nausea ; Pruritus ; Solubility ; Thoracotomy*

Recently, devices using radiofrequency energy have been developed for arthroscopic soft tissue ablation and shrinkage. The purpose of this study was to evaluate effect of radiofrequency energy on the biomechanical competence of thermal shrinkage of anterior cruciate ligament and was to demonstrate a new approach for radiofrequency energy, applying to ligamentous tissue in a dynamic fashion. Twelve New Zealand White rabbits, were divided into two experimental groups by right and left hindlimbs. Thermal shrinkage of the anterior cruciate ligament of rabbits produced using radiofrequency energy generator(N=12, group I). And untreated control group(N=12, group II). The percent shrinkage was calculated from the change of length of anterior cruciate ligament after radiofrequency energyinduced thermal shrinkage. The maximal tensile stress and linear stiffness of anterior cruciate ligament as biomechanical competence were assessed. The results obtained were as follows: 1. In the group I the percentage of shrinkage was 29.50Fo on the average. 2. The average of maximal tensile stress to failure was 271.24 kN in group I and 283.50 kN in group II. There was no significant difference(p=0.24) in the maximal tensile stress between two groups. 3. The average of linear stiffness in group I(179.16kN/mm) was higher than that of group II(148.20kN/mm). But there was no significant difference(p=0.078) between two groups. This study shows that radiofrequency energy appears to be safe to use on therma1 shrinkage of anterior cruciate ligament, which necessitate a mechanical tensile strength.
Animals ; Anterior Cruciate Ligament* ; Hindlimb ; Ligaments ; Mental Competency ; Rabbits ; Tensile Strength

Pedicle screw systems are stronger than previously used Harrington instruments. The systems have been thought to provide sufficient stability to the thoracolumbar burst fractures by merely short segment fusion. Currently some authors reported the metal failure and the loss of correction after the short segment instrumentations. Thirty-nine patients with thoracolumbar burst fractures underwent the long segment pedicle screw instrumentation and anterior interbody fusion at Ewha University Hospital from January 1991 to October 1993. Of these patients, thirty-two were reviewed in an attempt to analyze the result of the operation technique. The mean follow-up was 26 months. L1 was the most common level and twenty patients had neurologic deficits. The anterior decompression and interbody fusion were performed 2 weeks after the posterior instrumentation. We encouraged early ambulation with TLSO brace as soon as possible. Bony union was obtained in all cases and completed at an average 4.4 months after the operation. The average preoperative kyphosis, 17.4 became 3 after the operation and it was measured 4.2 at the final follow-up. The average correction loss was 1.2. Of the twenty patients with neurologic deficit, ten improved by one Frankel grade and four improved by two grades. Postoperative complications were three cases of the donor site pain. There was no metal failure. These data suggest that the long segment pedicle screw instrumentation and anterior interbody fusion are able to provide sufficient stability and the recommendable procedure for the thoracolumbar burst fractures than short segment instrumentation.
Braces ; Decompression ; Early Ambulation ; Follow-Up Studies ; Humans ; Kyphosis ; Neurologic Manifestations ; Pedicle Screws ; Postoperative Complications ; Spine ; Tissue Donors

PURPOSE: Deproteinized bovine bone substitutes are commonly used in dental regenerative surgery for treatment of alveolar defects. In this study, three different bovine bone minerals - OCS-B (NIBEC, Seoul, Korea), Bio-Oss (Geistlich - Pharma, Switzerland), Osteograft/N - 300 (OGN, Dentsply Friadent Ceramed. TN, USA) - were investigated to analyze the basic characteristics of commercially available bone substitutes. METHODS:Their physicochemical properties were evaluated by scanning electron microscopy, energy dispersive X-ray spectrometer (EDS), surface area analysis, and Kjeldahl protein analysis. Cell proliferation and alkaline phosphatase (ALP) activity of human osteosarcoma cells on different bovine bone minerals were evaluated. RESULTS: Three kinds of bone substitutes displayed different surface properties. Ca/P ratio of OCS - B shown to be lower than other two bovine bone minerals in EDS analysis. Bio-Oss had wider surface area and lower amount of residual protein than OCS - B and OGN. In addition Bio - Oss was proved to have lower cell proliferation and ALP activity due to lots of residual micro particles, compared with OCS - B and OGN. CONCLUSIONS: Based on the results of this study, three bovine bone minerals that produced by similar methods appear to have different property and characteristics. It is suggested that detailed studies and quality management is needed in operations for dental use and its biological effects on new bone formation.
Alkaline Phosphatase ; Bone Substitutes ; Cell Proliferation ; Humans ; Microscopy, Electron, Scanning ; Minerals ; Osteogenesis ; Osteosarcoma ; Polymethyl Methacrylate ; Statistics as Topic ; Surface Properties

Anaplastic large cell lymphoma (ALCLs) are a group CD30-positive mature T-cell lymphomas, an uncommon subtype of non-Hodgkin lymphomas, characterized by diverse clinical and genetic features. Among the types of ALCL, anaplastic lymphoma kinase (ALK)-negative ALCL, though typically involves the lymph nodes, can infrequently invade other tissues. When soft tissue involvement occurs, it may mimic the clinical presentation of infectious diseases, leading to potential misdiagnosis. Therefore, a histological examination is necessary to differentiate between ALK-negative ALCL and similar phenotypes associated with infectious conditions. This paper reports a case of ALCL, initially misdiagnosed as an infection.

No abstract available.
Animals ; Cadmium Poisoning* ; Cadmium* ; Olfactory Bulb* ; Rats*

Aneurysms arising from the posterior inferior cerebellar artery (PICA) are uncommon, with a reported incidence ranging between 0.5 and 2% of all the aneurysms in the brain. Most of them arise at the PICA origin from the vertebral artery, whereas distal PICA aneurysms are exceptional. We have experienced two consecutive cases of distal PICA aneurysms. Both patients were female and the first patient was 48 years old and the second patient was 60 years old. Cerebral angiography was performed immediately after admission and it showed an aneurysm located on the distal PICA. One patient was treated by a combined endovascular and surgical approach, and the other patient was treated by a surgical approach only. The former patient expired 8 days from the ictus. The latter patient had a good outcome during admission. Distal PICA aneurysms are exceptionally rare and they may be successfully treated with surgical or endovascular techniques. The therapeutic strategy, either surgical or endovascular, should be selected according to the condition of the patient and the arterial and aneurysmal morphology.
Aneurysm ; Arteries ; Brain ; Cerebral Angiography ; Endovascular Procedures ; Female ; Humans ; Incidence ; Intracranial Aneurysm ; Pica ; Vertebral Artery