Purpose: Dislocation is the second most common cause of failure, after implant loosening, in revisional THA (Total hip arthroplasty), and its evaluation and treatment still remain controversial issue. This study was undertaken to evaluate the risk factors after THA using the posterolateral approach and posterior soft tissue repair. Materials and Methods: Between January 1998 and May 2003, 211 consecutive primary total hip replacement arthroplasties using the posterolateral approach and posterior soft tissue repair were performed by the same surgeon. To compare the dislocation groups (6 cases) with the non-dislocation groups (205 cases), we randomized 120 of the non-dislocation cases. The risk factors for hip dislocation were categorized into patient factors and surgical factors. Patient factors included gender, age, preoperative diagnosis, underlying systemic disease, and alcoholic history. Surgical factors included position of the component (acetabular version and inclination, femoral anteversion), leg length discrepancy, and sum of anteversions of the cup and stem. Their parameters were measured on postoperative radiographs. Statistics were performed with Fishe`s Exact test and T test. Results: Dislocations occurred at an overall incidence rate of 2.8% (6/211cases). There were 4 (1.9%) cases of anterior dislocations and 2 (0.9%) cases of posterior dislocations. Dislocations occurred on average at postoperative day 6.1 and all dislocated hips were reduced with the closed method, except for one case that was treated surgically. There was no statistical significance in patient factors between the two groups, except for neurologic disease and alcoholic history. However, the sum of the acetabular and femoral anteversions in the anterior dislocation group was larger than that of the non-dislocation group by approximately 19 degrees. Conclusion: Our results demonstrated that by using the posterior approach and repair of soft tissue, the posterior dislocation rate after total hip replacement arthroplasty can be reduced and the sum of the acetabular and femoral anteversions had more influence on dislocations after THAs than did either anteversion alone.
Acetabulum ; Alcoholics ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Diagnosis ; Dislocations ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Leg ; Risk Factors*

PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated alpha-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. RESULTS: Mean age and mean gestational weeks in the study were 30+/-4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.
alpha-Fetoproteins ; Biomarkers ; Chorion ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Logistic Models ; Mothers ; Multivariate Analysis* ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, Second ; Pregnancy* ; Radioimmunoassay ; Rupture

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics

PURPOSE: Breast cancer is second most common cancer in women. Most of the patients with breast cancer treated with mastectomy take breast reconstruction. Nipple reconstruction is an important step in breast reconstruction. Many surgeons have investigated of nipple reconstruction using the flap technique after breast reconstruction with the autologous tissue. The objective of this study is to evaluate the results of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. METHODS: From April 2006 to May 2008, the authors treated 17 patients of nipple reconstruction using C-V flap technique, who received breast reconstruction only with the breast expander. As we have predicted decrease in the size of reconstructed nipple, we designed flap a little larger than wanted nipple size. Nipple splint was applied for 4-6 months for minimizing decrease of the size of reconstructed nipple. The diameter and height of the reconstructed nipple were measured and patient's satisfaction score was assessed. RESULTS: Mean follow-up duration was 12.5 months. Among the 17 patients, the average absorption rate by height of nipple was 47.0%. Partial necrosis was noted in 1 case, and treated well with conservative management. There were no other significant complications noted. Patient's satisfactory score was assessed by the height, design and location of the nipple. The average of satisfaction score was 85%, 68%, 62% and total average was 83%. CONCLUSION: The authors experienced 17 patients of nipple reconstruction using the C-V flap technique after breast reconstruction only with the breast expander. The absorption rate of the size of the nipple, complications and patient's satisfactory score of this study were similar to those of nipple reconstruction after breast reconstruction with the autologous tissue. It is expected that nipple reconstruction after breast reconstruction only with the breast expander is safe and reliable. It is considered that a long-term study is necessary.
Absorption ; Breast ; Breast Neoplasms ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Necrosis ; Nipples ; Splints

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult ; Amniotic Fluid* ; Anaphylaxis ; Anoxia ; Cardiopulmonary Bypass ; Cesarean Section ; Cognition ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnant Women ; Pulmonary Circulation ; Shock

PURPOSE: Gynecomastia is an abnormal increase in the volume of the male breast. Subcutaneous mastectomy was the first surgical treatment for gynecomastia. But because of the complications such as nerve injury and scar formation, subcutaneous mastectomy has been substituted with liposuction. Recently various techniques including ultrasound-assisted liposuction has been used for treatment of gynecomastia. The purpose of this study is to evaluate the results of XPS(R) microresector (Shaver) for treatment of gynecomastia. METHODS: 17 patients, 33 breasts of gynecomastia, Simon grade I or II have been treated with XPS(R) microresector (Shaver). The mean age was 24.5. The subcutaneous tissue and glandular tissue were removed with XPS(R) microresector (Shaver). The operation time, the weight of removed tissue and patients' satisfaction score were accessed. RESULTS: The mean operation time was 78.2 minutes. The mean weight of removed tissue was 113.8 g. There were no significant complications such as necrosis, hematoma, infection or scar contracture. Patients' satisfactory score of scar, shape and confidence were 8.4, 8.2 and 8.4 respectively. As the average score was 8.3, most of the patients were satisfied with their breasts. CONCLUSION: The authors have treated 17 patients suffering from gynecomastia with XPS(R) microresector (Shaver). We obtained short operation time, early recovery, minimal operative scar and less complications with XPS(R) microresector (Shaver) for the treatment of gynecomastia, and patients were satisfied with the results of our method. We concluded that XPS(R) microresector (Shaver) is an alternative option for the treatment of gynecomastia.
Breast ; Cicatrix ; Contracture ; Gynecomastia ; Hematoma ; Humans ; Lipectomy ; Male ; Mastectomy, Subcutaneous ; Necrosis ; Stress, Psychological ; Subcutaneous Tissue

Golf is low demanded activity and becoming more popular. But it often occur problems in back, shoulder, elbow and wrist. Golf injuries in professional golfer are related overuse and frequency, while in amateur are related wrong swing technique. Also muscle activities in swing are different between professional and amateur. We report partial tear of pronator teres in middle aged amateur golfer with literatures.
Elbow ; Golf ; Humans ; Middle Aged ; Muscles ; Shoulder ; Wrist

PURPOSE: Surgical excision of the subcutaneous tissues, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice in treating osmidrosis for several decades. However, long periods of postoperative immobilization of a shoulder joint, partial necrosis of skin flaps or the possibility of hematoma and scars have occurred frequently. So we used XPS(R) microresector(Shaver) in procedure which requires removal of soft tissue for comparing results between surgical excision and the laters. METHODS: From January 2007 to February 2008, a total of 20 patients(8 male and 12 female) underwent XPS(R) microresector(Shaver) assisted aspiration for treating osmidrosis. The mean age of the subjects was 21.9, and we tried to analyze some advantages of XPS(R) microresector(Shaver). RESULTS: The average operation time was 61.6 minutes. This results can show that the patients who received XPS(R) microresector(Shaver) assisted aspiration can accomplish better outcomes than any other procedures in terms of operation time at least. Moreover, no significant postoperative complications occurred in our studies. Subjects have been followed up from 2 months to 1 year and among these patients, no one suffered from critical complications. CONCLUSION: In brief, XPS(R) microresector(Shaver) is able to shorten the time of operation and simplify the procedures relatively and this device has more superiorities in wound healing by maintaining of vascularized dermal skin flaps. It means that XPS(R) microresector (Shaver) can prevent flap necrosis, axillary hair loss and minimalize scarring and bleeding. Thus, we expect that these advantages can lead to better patient's comfort and self-confidence than several previous procedures.
Cicatrix ; Hair ; Hematoma ; Hemorrhage ; Humans ; Immobilization ; Male ; Necrosis ; Postoperative Complications ; Shoulder Joint ; Skin ; Subcutaneous Tissue ; Wound Healing

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

PURPOSE: Partial nephrectomy has a similar oncologic outcome to radical nephrectomy while reducing cardiac and metabolic morbidity. However, previous studies reported that partial nephrectomy had been underutilized. The purpose of this study is to analyze trends in the use of partial nephrectomy in Korea and evaluate which individual factors and hospital factor influenced the operative approach. MATERIALS AND METHODS: Using URO-PDS database, 11560 patients underwent nephrectomy for renal cell carcinoma between 2006 and 2010 were identified. International Classification of Disease (ICD-9) diagnosis codes were applied to target subject of interest. Logistic regression was applied to identify determinants of partial nephrectomy. RESULTS: Over the study period, the proportion of partial nephrectomies has steadily increased from 9.4% in 2006 to 30.4% in 2010 (p<0.001). Deviation of utilization in partial nephrectomy has been observed based on the area (p<0.001) and type of surgery (p<0.001). Individual of younger age, as well as male, were more likely to be treated with partial nephrectomy (p<0.001 for each). Furthermore, Patient treated at hospitals with higher nephrectomy volume were more prone to be treated with partial nephrectomy (p<0.001 for each). CONCLUSIONS: Partial nephrectomies have been increasingly performed over the study period but are still underutilized.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Humans ; Korea* ; Logistic Models ; Male ; Nephrectomy*