Closed interlocking nailing has become a common method of treatment of femoral fractures in adults. Interlocking nailing had a tendency toward rotational deformity and shortening. Therefore, we determined anteversion of the femoral neck after closed IM nailing of the femoral fractures. Femoral rotational deformity in both leg was determined by the construction of a line through the femoral neck and another through the transcondylar plane of the distal portion of the femur, using the CT scanning. We performed a retrospective study of 15 patients treated with closed IM nailing for femoral shaft fractures from 1989 to 1994. 1. The average differences in anteversion angle was 12.9 degree. 2. 3 cases(50%) in 6 cases that have difference more than 15° are accompanied with ispilateral injury of the knee joint and the lower leg. 3. Angle difference of the rotational deformity of proximal or distal femoral fractures is 15.5° which is 3.5° larger than that of fractures of femoral midshaft, 12.0°.
Adult ; Congenital Abnormalities ; Femoral Fractures ; Femur ; Femur Neck ; Humans ; Knee Joint ; Leg ; Methods ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: We investigated the clinical characteristics of IDDM patients, treated with NPH only, and evaluated current problems by measurement of serial blood glucose, insulin, C-peptide for 12 hours after administration of intermediate-acting insulin. METHODS: We studied 19 IDDM patients who had been diagnosed and followed up on a regular basis at Severance hospital. They were assigned into 2 groups, one(HbA1c high group) with HbA1c above 12%, the other(HbA1c low group) showing HbA1c below 12%. Their Heights, DM durations, HbA1c, basal C-peptides were primarily measured. Using continuous withdrawal pump, samples were taken every hour for 12 hours from 7:00 am. And serial blood glucose, insulin, C-peptide were assayed. RESULTS: 1) The mean HbA1c of the high group was 16.5+/-3.5% and that of the low group was 11.0+/-0.6%. There were no differences in clinical characteristics. 2) In HbA1c high group, fasting blood glucose, and mean blood glucose levels for 3hours were 156+/-85mg%, 284+/-125mg%(8,9,10am), 250+/-133mg% 11,12am,1pm), 252+/-122mg%(2,3,4pm), and 182+/-105 mg%(5,6,7pm), respectively. In low group, fasting blood glucose, and mean blood glucose levels for 3hours were 130+/-71mg%, 275+/-109 mg%(8,9,10am), 249+/-129mg%(11,12am,1pm), 231+/-81mg%(2,3,4pm), 158+/-62mg%(5,6,7pm), respectively. 3) Fasting blood insulin level was 51+/-47 U/l in high group, 62+/-62 U/l in low group. Thereafter low HbA1c group showed higher insulin levels than high HbA1c group. 4) Fasting blood C-peptide was 0.16+/-0.20 g/l in the high group, and 0.34+/-0.14 g/l in low group. Thereafter low group developed higher C-peptide responses than high group. The curve of C-peptide showed similar change of blood glucose, and maximal response followed 1-2 hours after maximal level of blood glucose. CONCLUSIONS: We concluded that short-acting insulin should be included for good control of blood glucose. Although fasting & dinner blood sugar seemed to be under fair control, intermediate-acting insulin used alone was not effective in preventing severe blood sugar elevation after morning meal.
Blood Glucose* ; Breakfast ; C-Peptide ; Diabetes Mellitus, Type 1* ; Fasting ; Humans ; Insulin* ; Insulin, Short-Acting ; Meals

The intertrochanteric fracture of the femur occurs frequently in the elderly who has osteoporosis. These fractures had been treated with many fixation devices. Recently dynamic hip screws been commomly used. But, some complications were reported by this fixation the patients who were osteoporotic and/or who had unstable type fracture. We have analysed the roentgenograms and the medical records to study impaction degree and change of neck-shaft angle according to fracture type and degree of osteoporosis in the 35 patiensts wit minimum 1 year follow-up who have intertrochanteric fracture of the femur treated with dynamic hip screws, from Jhn. 1989 to Jun. 1993, retrospectively. The results obtained were as follows; 1. The most common fracture type by Bord-Griffin classification was type I, 19 cases(57%), and the most common osteoporotic by Sight's index was grade II, 21 cases(60%). 2. There were no significant differences of impaction degree and neck-shaft angle according to the fracture types or osteoporosis degrees. 3. The mean impaction degree of fracture site was 9.3mm and the mean neck-shaft angle change was 0.8。 of varus angulation.
Aged ; Classification ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip ; Humans ; Medical Records ; Osteoporosis ; Retrospective Studies

OBJECTIVES: Dialysis patients' nutritional indicators are quite subjective and complex and cannot be easily measured in clinical settings. Based on previous reports that total lymphocyte count (TLC) and subpopulation lymphocyte counts (SLCs) are associated with nutritional status in patients with dialysis, we designed this study to examine the relationships of the TLC and SLCs with clinical outcome and nutritional status in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD). METHODS: In this prospective, observational study, we enrolled 66 patients (50 HD patients and 16 PD patients) receiving stable maintenance dialysis. We evaluated the baseline parameters of height; weight; TLC; SLCs expressing CD3, CD4, CD8 and CD19; CBC; iron profile (iron, TIBC, ferritin); BUN; Cr; Na; K; total CO2; Ca; P; iPTH; protein; albumin; total cholesterol; HDL; LDL; uric acid and CRP and calculated Onodera's prognostic nutritional index (OPNI) and the Geriatric Nutritional Risk Index (GNRI) at baseline and three months. To analyze differences in the TLC and SLCs between the HD group and the PD group, we performed an independent samples t-test. Logistic regression analysis was performed to predict malnutrition in dialysis patients. In addition, to analyze changes in TLC, SLCs expressing each marker (CD3, CD4, CD8 and CD19) and other nutritional markers, we performed general linear model (GLM)-repeated measures ANOVA. RESULTS: Mean age was 55.8 ± 12.7 years in HD paitents and 49.8 ± 14.5 years in PD patients. The duration of dialysis was 59.7 ± 52.9 months in HD patients and 66.1 ± 33.6 years in PD patients. Logistic regression analysis revealed that patients aged 60 years or older, women, and those whose CD19 SLCs were lower than 100 had a higher risk of developing malnutrition. In GLM-repeated measures ANOVA, CD19 SLCs were significantly higher in women and in patients with a shorter period of dialysis. CONCLUSIONS: Our results indicate that GNRI, OPNI, TLC and SLCs (especially CD19 count) may be significant nutritional markers in HD and PD patients.
Cholesterol ; Dialysis* ; Female ; Humans ; Iron ; Linear Models ; Logistic Models ; Lymphocyte Count* ; Lymphocytes* ; Malnutrition ; Nutrition Assessment ; Nutritional Status* ; Observational Study ; Peritoneal Dialysis ; Prospective Studies ; Renal Dialysis ; Uric Acid

BACKGROUNDS/AIMS: Although laparoscopic cholecystectomy is a common and widely accepted technique, the use of prophylactic antibiotics in elective laparoscopic cholecystectomy still remains controversial. The aim of this study is to determine whether prophylactic antibiotics could prevent surgical site infection after elective laparoscopic cholecystectomy and to identify any risk factors for surgical site infection. METHODS: This study included 471 patients undergoing laparoscopic cholecystectomy between January 2009 and May 2012. Period 1 patients (279) received second generation cephalosporin 1 g intravenously after induction of anesthesia, and Period 2 patients (192) were not given prophylactic antibiotics. The characteristics and surgical site infections of the patients were compared and analyzed. RESULTS: The overall rate of surgical site infection was 1.69% for the total of 471 patients. The incidence of surgical site infection was similar for the two Periods: 5 of 279 patients (1.79%) in Period 1, 3 of 192 patients (1.56%) in Period 2 (p=0.973). All of the patients with surgical site infections were well treated under conservative treatments without any sequelae. The preoperative albumin level (p=0.023) contributed to surgical site infection. CONCLUSIONS: Prophylactic antibiotics are not necessary for elective laparoscopic cholecystectomy but patients in poor nutritional state with low albumin level should consider prophylactic antibiotics.
Anesthesia ; Anti-Bacterial Agents* ; Antibiotic Prophylaxis ; Cholecystectomy, Laparoscopic* ; Humans ; Incidence ; Nutrition Assessment ; Risk Factors ; Surgical Wound Infection

BACKGROUND: The stomach can be generally classified anatomically into three parts; fundus, corpus, and antrum. It has not been well demonstrated how the three regions contribute to specified gastric motility. In the present study, the regional differences on contractile response and intracellular Ca2+ levels ([Ca2+]i) were investigated in a mouse gastric muscle. METHODS: An isometrical contraction was measured with a computerized physiograph, and [Ca2+]i was measured with fura-PE3/AM, a fluorescent Ca2+ indicator in gastric smooth muscle from mice. RESULTS: Carbachol (CCh), a potent muscarinic receptor agonist, generated rhythmic contractions in a dose dependent manner, superimposed on tonic components in the antral muscle. Whereas similar contractile responses to CCh was obtained in the antrum, CCh evoked tonic components predominantly. CCh increased [Ca2+]i in a dose dependent manner in both the antral and fundic smooth muscle. However, the increment of [Ca2+]i in the fundus was greater than that of the antrum. Verapamil (10nM), a l-type Ca2+ channel blocker, inhibited completely the contraction and [Ca2+]i induced by CCh in the antral strips, whereas the responses in the fundus showed a resistance to verapamil. CONCLUSIONS: These results suggest that muscarinic stimulation has a regional difference on muscle contractility and [Ca2+]i, which is mediated by differences of Ca2+ movement in mouse gastric muscle.
Animals ; Carbachol ; Mice ; Muscle, Smooth* ; Receptors, Muscarinic ; Stomach ; Verapamil

STUDY DESIGN: A case report. OBJECTIVES: This case report presents an elderly male who sustained compression fractures twice on the instrumented end vertebra following a spinal fusion with pedicle screws. SUMMARY OF LITERATURE REVIEW: Because of its low incidence, there is considerable debate regarding an optimal treatment of adjacent segment fracture after long lumbar fusion. Almost all of the reports about adjacent segment fracture are about adjacent vertebral fractures rather than the instrumented vertebral fractures. MATERIALS AND METHODS: A 69 year-old male who was admitted with low back pains of no apparent physical injury underwent pedicle subtraction osteotomy and posterolateral fusion for L3 vertebral fracture and post-traumatic kyphosis. Extension of the fusion segment was performed two months after the initial operation to correct his compression fracture of the instrumented end vertebra, followed by conservative treatments due to a second compression fracture of the instrumented end vertebra two months after the second surgery. RESULTS: Conservative treatment was performed with TLSO brace, after which the fracture was gradually stabilized. CONCLUSIONS: Further research via additional case studies is required to better understand its cause and to develop effective treatment options.
Aged ; Braces ; Fractures, Compression ; Humans ; Incidence ; Kyphosis ; Low Back Pain ; Male ; Osteotomy ; Spinal Fusion ; Spine

To analyze the infectious causes and clinical symptoms of febrile infants aged less than 3 months presenting to a Pediatric Emergency Medical Center (PEMC) and to propose more efficient, evidence-based management and treatment. We conducted a retrospective study of 462 febrile infants aged less than 3 months who visited PEMC at Keimyung University Dongsan Medical Center from January 2015 to June 2016. Infants' sex, age, fever duration, and laboratory findings, including bacterial or viral pathogens, were recorded. To evaluate clinical signs, one point per sign was given for grunting, decreased activity, and the presence of cyanosis; total scores were compared between the bacterial infection (BI) and non-bacterial infection (NBI) groups. BI was diagnosed in 118 (25.5%) infants, and no BI was diagnosed in 344 (74.5%) infants. Escherichia coli was the most frequently isolated pathogen, accounting for 80.5% (n = 95) of all infections (n = 118). Statistically significant differences in sex, the duration of fever, sign scores, white blood cell count, neutrophil count, lymphocyte count, and C-reactive protein (CRP) level were found between the BI and NBI groups. The cut-off value for CRP was 1.445 mg/dL, with sensitivity and specificity values of 76.3% and 75.9%, respectively, in BI patients, as determined by the receiver operating characteristic curve. As more PEMCs are being built in Korea, hospital accessibility is better; thus, it may be possible to perform outpatient management of young, febrile infants aged younger than 3 months without antibiotics and lumbar puncture using individual sign scores and laboratory findings.
Anti-Bacterial Agents ; Bacterial Infections ; C-Reactive Protein ; Cyanosis ; Emergencies ; Escherichia coli ; Fever ; Humans ; Infant* ; Korea ; Leukocyte Count ; Lymphocyte Count ; Neutrophils ; Outpatients ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spinal Puncture

Pheochromocytoma during pregnancy is very rare tumor, and this condition is life threatening to both mother and fetus. We describe a case of pheochromocytoma antenatally diagnosed at the midtrimester in gestation. A patient was transferred to National Medical Center during gestational week 24 with severe hypertension, generalized edema. Pheochromocytoma caused by a left adrenal mass was diagnosed. The patient was treated with titrated dose of phenoxybenzamine, propranolol, and intravenous nicardipine, but, intermittent severe hypertension was developed. At 33 weeks gestation, fetal distress was developed, and emergent c-sec was done. Two weeks after delivery, she underwent a successful left adrenalectomy. Two months after surgery, all antihypertensive medications were discontinued and her blood pressure have remained normal range.
Adrenalectomy ; Blood Pressure ; Edema ; Female ; Fetal Distress ; Fetus ; Humans ; Hypertension ; Mothers ; Nicardipine ; Phenoxybenzamine ; Pheochromocytoma* ; Pregnancy Trimester, Second ; Pregnancy* ; Propranolol ; Reference Values

BACKGROUND: The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT). METHODS: We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT. RESULTS: We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality. CONCLUSION: APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT.
Acute Kidney Injury* ; APACHE ; Critical Illness* ; Humans ; Hydrogen-Ion Concentration ; Hypophosphatemia* ; Mortality ; Renal Replacement Therapy* ; Retrospective Studies ; Risk Factors