BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Arthrography* ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joint Instability ; Recurrence ; Retrospective Studies ; Shoulder*

No abstract available.
Nursing Homes* ; Nursing* ; Nutritional Status*

PURPOSE: The clinical characteristics and post-operative prognosis of dissociated vertical deviation (DVD) combined with exotropia was evaluated. METHOD & MATERIALS: The clinical appearance such as the frequency of DVD, vision, amount of deviation, stereoacuity, sensory abnormality, the presence of latent nystagmus, head tilting and operation results were evaluated in patients who were diagnosed with comitant exotropia followed by surgical correction with 3 month follow-up. RESULTS: Eight (16.0%) patients had exotropia combined with DVD, the combined DVD showed an angle of vertical deviation 15.88+/-7.26 delta, for the right eye and 13.50+/-6.55 deltafor the left eye in the primary position. All but 1 patient showed subnormal stereoacuity in the Titmus stereopsis test and most showed suppression in near and far in the Worth 4 dot test. Four (50%) patients were associated with latent nystagmus and one (12.5%) patient showed head tilting. Three months after the operation, all patients showed a residual DVD under 8 delta. CONCLUSION: DVD is frequently combined with exotropia and is associated with decreased stereoacuity, latent nystagmus, head tilting, inferior oblique overaction (IOOA), and superior oblique overaction (SOOA). DVD showed no relation to the amount of deviation of exotropia but was usually associated with a small angle of exotropia (<25 delta) or large angle of exotropia (> or =50 delta). The correction of DVD with exotropia showed satisfactory results.
Depth Perception ; Exotropia* ; Follow-Up Studies ; Head ; Humans ; Prognosis

Gelastic (laughing) epilepsy characterized as paroxysmal involuntary laughing episodes usually begins in infancy or childhood. It is known to be poorly respond to medical or surgical treatments. This unique seizure is rare and associated with variable etiologies, especially with hypothalamic harmatoma. But still, relationship between harmatoma and seizure is unclear. We presented three cases of gelastic seizures which were diagnosed by clinical history, 24 hour video EEG monitoring and radiological studies. Two of them were associated with hypothalamic harmatoma, but etiology of one case with normal brain structure can not be documented. Anticonvulsant agents were prescribed on all cases and surgical interventions(gamma knife surgery or subtotal resection) were done on harmatoma cases. After medical and surgical treatments, one case showed poor prognosis but two cases showed exellent outcome with seizure free state.
Brain ; Electroencephalography ; Epilepsy ; Prognosis ; Seizures*

No abstract available.
Humans

No abstract available.
Humans

The laparoscopic cholecystectomy has been rapidly accepted as the standard treatment for gallbladder stones because its minimally invasive nature offers a significant advantage over an open cholecystectomy in terms of postoperative morbidity & recovery. The endoscopic sphinterotomy has become the primary treatment for common bile duct stones, yielding a duct clearance rate of approximately 90%. The laparoscopic cholecystectomy combined with the preoperative endoscopic sphinterotomy is becoming more widely employed as a therapeutic option for the management of gallbladder stones & common bile-duct stones. The authors retrospectively analyzed 71 patients who had been treated by an open cholecystectomy and a common bile-duct exploration (group A) and 35 patients who had been treated by a laparoscopic cholecystectomy plus endoscopic sphinterotomy (group B) at the Department of Surgery, Jungang Gil Hospital, from March 1993 to January 1996. The diagnotic procedures performed were ultrasonography ERC and DISIDA scan, and abdominal computed tomography. Intraoperative cholangiograms were successfully performed in 59 cases from group A and in 5 cases from group B. Successful duct clearance was achieved in 87.3% of the group A cases and in 87.5% of the group B cases. The operation time, the postoperative hospital stay, and postoperative complications were significantly lower for group B than for group A. The major postoperative complication was wound pain & infection for both groups. We conclude that in comparison with group A, group B appeared to have a similar clearance rate, a much lower morbidity, a shorter hospital stay, an earlier return to working fitness, and a better cosmetic result.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Choledocholithiasis* ; Cholelithiasis* ; Common Bile Duct ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Return to Work ; Ultrasonography ; Wounds and Injuries

PURPOSE: To assess the myotoxicity of local anesthetics and antibiotics which are considered as the main causes of diplopia and extraocular motility disturbance following cataract surgery. METHODS: A total of 48 rabbits were classified into 4 groups. The control group received an injection of 0.3 ml normal saline in the subconjunctival space above the superior rectus muscle. The first experimental group received an injection of the same amount of a local anesthetic (2% lidocaine) in the same manner as the control group. The second group received an injection of 0.3 ml of a local anesthetic directly into the extraocular muscle (superior rectus muscle), the third group received an injection of 0.3 ml of an antibiotic (gentamicin) in the subconjunctival space above the superior rectus muscle. Histologic and electron microscopic changes following injections were compared over time in each group. RESULTS: Light microscopic findings showed that subconjunctival injections of antibiotics caused the most severe inflammatory and fibrotic reactions of the muscular fascicle, whereas subconjunctival injections of local anesthetics led to the least damage of the muscular fascicle and less infiltration of inflammatory cells. Changes in histological findings showed that necrotic muscle fibers and inflammatory cell infiltration at 1 week following injections. Basophilic myogenous satellite cells indicating regeneration of the damaged muscles appeared thereafter. At 2 and 4 weeks, the group injected with antibiotic showed local and consistent infiltration of inflammatory cells and fibrosis, whereas the groups injected with anesthetics showed regeneration of most of the damaged fascicle. CONCLUSIONS: In terms of temporary or permanent diplopia following an injection of local anesthetics or antibiotics after cataract surgery, toxicity of anesthetics or antibiotics on extraocular muscle is the main cause from these Results.
Anesthetics ; Anesthetics, Local ; Anti-Bacterial Agents ; Basophils ; Cataract* ; Diplopia* ; Fibrosis ; Gentamicins ; Lidocaine ; Muscles ; Rabbits ; Regeneration

BACKGROUND: Nosocomial urinary tract infection (UTI) is the most frequent nosocomial infection and could be prevented through the intensive nosocomial infection control (NIC) or restricting the use of indwelling urinary catheter. The efficiency of the intensive NIC to prevent UTI for the patients with indwelling urinary catheter was investigated. METHODS: Study population consisted of 296 patients with indwelling urinary catheter in the intensive care unit (lCU) who didn't have UTI on admission. The incidence rates of nosocomial UTI were compared between 146 patients being provided with ordinary NIC from March 15 to July 31, 1995 (control group) and 150 patients being provided with intensive NIC from January 16 to October 31, 1996 (NIC group). RESULTS: There was significant decrease in the incidence of nosocomial UTI in the NIC group (35 UTI among 150 patients, 23.8%) than in me control group (68 UTI among 146 patients, 46.6%) (P<0.01). But there were no differences in age distribution, sex, admission route to the ICU and underlying diagnoses between two groups. Interval between insertion of urinary catheter and development of UTI was significantly prolonged in the NIC group (10.0 +/- 3.5 days) than in the control group(7.6 +/- 3.9 days) (p < 0.01) despite there were no differences in the duration of urinary catheterization in two groups. The most common organism isolated from the urine of the patients was Candida tropicalis in both groups and the other organisms were in the order of Enterococcus faecium, Pseudomonas putida, Staphylococcus epidermidis in the control group and in the order of Staphylococcus aureus, Acinetobacter baumannii, Enterococcus faecalis in the NIC group. Four of five Staphylococcus aureus isolated in NIC group were MRSA. CONCLUSION: This study result confirms the efficiency of intensive NIC fur decrease in the incidence of nosocomial UTI in patients with indwelling urinary catheter. But the incidence of nosocomial UTI should be decreased further through the continuous emphasis on NIC and it seems to be necessary to study the effect of each component of NIC with proper control of the risk factors for the development of nosocomial UTI in the future.
Acinetobacter baumannii ; Age Distribution ; Candida tropicalis ; Cross Infection* ; Diagnosis ; Enterococcus faecalis ; Enterococcus faecium ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Methicillin-Resistant Staphylococcus aureus ; Pseudomonas putida ; Risk Factors ; Staphylococcus aureus ; Staphylococcus epidermidis ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

Gastritis cystica profunda is an uncommon benign mass that usually occurs on the gastric side of the site of a gastroenterostomy, but has also been known to develop in which has not been operated on. We report the case of stomach a 51-years-old man with pathologically proven gastritis cystica profunda. This patient had not undergone gastric surgery and CT showed a well-defined, 3 cm sized, cystic mass at the gastric antrum.
Gastritis* ; Gastroenterostomy ; Humans ; Pyloric Antrum ; Stomach