No Abstract Available.
Arthroplasty* ; Knee Joint* ; Knee*

Reconstruction of the male urethra is required for a multitude of congenital anomalies, such as hypospadias and epispadias, as well as fort acquired lesions such as stricture disease and trauma. No method is appropriate for all types of repair of the urethra. A successful surgical reconstruction of the urethra is the result of a proper operative selection that depends on the site and length of the disrupted urethra and also depends on, as well as the experience of the surgeon. Reconstruction of the urethra has been performed by the use of homografts, silicone tubes, grafts taken from the bladder mucosa. But serious postoperative problems, such as urinary fistula, urethrostenosis, stricture of the site of urethral anastomosis, and diverticulum formation, are not uncommon. Especially, reconstruction of Proximal urethra is very difficult because of limitations of operation field exposure and flap transfer. However, the hairless median scrotal skin flap with the scrotal septum attached, rich in neurovascular plexus, is ideal material for creating a new urethra without interference to its blood supply and other complications. We experienced a successful reconstruction of the proximal urethral defect in about 8cm length and perineal sore with pedicled scrotal septal flap and gracilis musculocutaneous flap, respectively.
Allografts ; Constriction, Pathologic ; Diverticulum ; Epispadias ; Female ; Humans ; Hypospadias ; Male ; Mucous Membrane ; Myocutaneous Flap ; Silicones ; Skin ; Transplants ; Urethra ; Urinary Bladder ; Urinary Fistula

OBJECTIVE: To investigate the effect of laterally wedged insole on static balance of patients with degenerative osteoarthritic knees. METHOD: Eighteen female patients were diagnosed with medial compartment knee degenerative osteoarthritis (OA) based on symptoms and simple X-rays. Patients were studied while they stood wearing shoes with the 5 degrees or 10 degrees lateral wedged insoles compared with a bare foot. Patients chose a comfortable stance with feet spread apart, slightly turned outwards, and were asked to look straight ahead at a fixed point in a quiet room. Postural sway and weight load asymmetry were recorded while the patients were standing on two adjacent force platforms during a 30 second trial. RESULTS: Postural sway and weight load asymmetry for 30 seconds were not significantly changed by wearing laterally wedged insoles with varying elevations (p>0.05). CONCLUSION: The degree of the postural sway and weight load asymmetry for 30 seconds with the insole were not affected by the tilt of the lateral wedge.
Female ; Foot ; Humans ; Knee* ; Osteoarthritis* ; Osteoarthritis, Knee ; Shoes

PURPOSE: The purpose of this study was to evaluate the feasibility and potential benefits of Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort system. The surgeon inserts the nondominant hand into the abdomen while the pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic surgery. This approach provides an excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. METHODS: A prospective study was performed in patients who had undergone surgical intervention with the HandPort system at Ewha Womans University Mok-Dong Hospital. The surgeon was free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. The surgeon inserted the nondominant hand into the abdomen while the pneumoperitoneum was generally maintained at 13 mmHg. RESULTS: Thirteen patients were entered in the study. Operations included radical gastrectomy in 8 cases, subtotal gastrectomy in 1 case, hemicolecotmy in 2, distal pancreatectomy with splenectomy in 1, nephrectomy with splenectomy in 1. The mean incision size for the HandPort device was 7.5 cm for the nondominant hand. None of the patients required conversion to open surgery as a result of an unmanageable air leak. There were no postoperative problems and no cases of mortality. CONCLUSION: HALS with the HandPort system is helpful in complex laparoscopic surgery and appeared to be useful in minimally invasive procedures considered too complex for,a laparoscopic approach.
Abdomen ; Conversion to Open Surgery ; Female ; Gastrectomy ; Hand ; Hand-Assisted Laparoscopy* ; Hemostasis ; Humans ; Laparoscopy ; Mortality ; Nephrectomy ; Pancreatectomy ; Pneumoperitoneum ; Prospective Studies ; Splenectomy

PURPOSE: MRI has been widely used in the evaluation of shoulder diseases in many athletic patients. The purpose of this study was to evaluate the usefulness of MRI in treatment of shoulder diseases in athletes. MATERIALS AND METHODS: Fifty-seven athletes were evaluated for shoulder diseases from March 1995 through July 1997. MRI was performed in thirty cases (53%). We analyzed the findings of MRI and checked if operation was determined by MRI findings. RESULTS: MRI findings revealed rotator cuff tear in 6 cases (20.0%), including one full thickness tear and five partial thickness tear. Among 57 cases, four cases (7.0%) were operated. Only in one case (3.3%) was open acromioplasty and rotator cuff repair in accordance with the finding of full thickness tear of rotator cuff on MRI decided upon. One case, which was initially treated conservatively, was treated by arthroscopic acromioplasty later. The two other cases were treated with arthroscopic acromioplasty and Bankart repair with capsular shift without MRI. CONCLUSIONS: MRI is not so useful for determining surgery in initial examination of shoulder diseases of athletes. MRI should be better reserved for cases with rotator cuff disease developed after trauma, cases without improvement by conservative measures or the unusual cases with difficulty in clinical diagnosis.
Athletes* ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Rotator Cuff ; Shoulder* ; Sports

OBJECTIVE: To evaluate the effects of stretching exercise on the head speed of golf club and driving distance. METHOD: 58 male golfers (20 professionals, 22 amateurs, 16 beginners) were included in the study. They carried out stretching exercise programs related to muscles of trunk, upper and lower extremities for 5 and 30 minutes. The head speed of golf club and driving distance were measured before and after the stretching exercise. The effects of stretching exercise programs on the head speed and driving distance were assessed. RESULTS: The head speed increased significantly in amateur and beginner groups after 30 minutes' stretching. In professional group, the head speed increased significantly after 5 minutes' stretching, but no more increment was found after 30 minutes' stretching. Driving distance increased significantly in all groups after 5 minutes' stretching. After 30 minutes' stretching, much more increment was found compared to 5 minutes' stretching. CONCLUSION: Sufficient stretching exercise program before golf swing can increase the head speed of club and driving distance. We recommend stretching exercise to improve golf performance.
Golf* ; Head* ; Humans ; Lower Extremity ; Male ; Muscles

Objectives: . This study evaluated the surgical outcomes of patients with Beckwith-Wiedemann syndrome who underwent tongue-reduction surgery and analyzed whether the malocclusion and mandibular prognathism caused by macroglossia could be improved. Methods: . A retrospective medical record review was performed for 11 patients with Beckwith-Wiedemann syndrome whose macroglossia was surgically treated. Demographic data, symptoms and signs, and intraoperative and postoperative surgical outcomes were evaluated. Surgery was performed by a single surgeon using the “keyhole” technique, involving midline elliptical excision and anterior wedge resection. Preoperative and postoperative plain skull lateral X-rays were evaluated to assess prognathism improvement. Results: . The median age at the time of surgery was 35.09 months, and the ratio of males to females was 4:7. The median surgical time was 98±31.45 minutes, and the median duration of the postoperative intensive care unit stay was 3.81±2.4 days. There were no airway complications. Two patients (18.2%) had postoperative wound dehiscence; however, there was no nerve damage, recurrence, or other complications. Among the five patients who underwent postoperative speech evaluation, all showed normal speech development, except one patient who had brain dysfunction and developmental delay. Measurements of the A point-nasion-B point (ANB) angles and sella-nasion-B point (SNB) angles (point A is the most concave point of the anterior maxilla; point B is the most concave point on the mandibular symphysis) on plain X-rays showed a significant decrease in the postoperative SNB angle (P <0.001) and a significant increase in the ANB angle (P <0.011). Conclusion . Tongue-reduction surgery is an effective and safe technique for severe forms of macroglossia associated with Beckwith-Wiedemann syndrome. In addition, it improves mandibular prognathism in young Beckwith-Wiedemann syndrome patients with macroglossia.

A 59 year-old female patient suffered from complex regional pain syndrome in left hemiplegia, was managed to stellate ganglion block (SGB) with 5 ml of 1 % lidocaine. The SGB was performed twice previously, with no side effects. And the third SGB was done in the same manner after negative aspiration testing. Two minutes later, she developed respiratory difficulty with increased blood pressure. Immediately airway management was performed by mask ventilation with oxygen. But ten minutes later, she developed respiratory arrest with unconsciousness and intubation was performed. Soon she recovered spontaneous respiration and the blood pressure returned to the former level. Despite taking all precautions during SGB, complications such as respiratory arrest and hypertension may occur even in the hands of an experienced physician. Therefore, before starting SGB, all resuscitation drugs and equipment must be ready for use in case any emergency develops.
Airway Management ; Blood Pressure* ; Emergencies ; Female ; Hand ; Hemiplegia ; Humans ; Hypertension ; Intubation ; Lidocaine ; Masks ; Middle Aged ; Oxygen ; Respiration ; Resuscitation ; Stellate Ganglion* ; Unconsciousness* ; Ventilation

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Risk Assessment ; Risk Factors ; Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy ; Survival Analysis ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated. METHODS: Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated. RESULTS: Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis. CONCLUSIONS: Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.
Acinetobacter/classification/*isolation & purification ; Acinetobacter Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Cerebrospinal Fluid/microbiology ; Cross Infection/cerebrospinal fluid/diagnosis/*microbiology/mortality/*therapy ; Drug Resistance, Bacterial ; Female ; Humans ; Logistic Models ; Male ; Meningitis, Bacterial/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Staphylococcal Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality ; Staphylococcus/classification/*isolation & purification ; Time Factors ; Treatment Outcome ; Young Adult