Total knee arthroplasty has been associated with marked blood loss despite the use of a tourniquet and minimal postoperative suction drainage. The purpose of this study was to determine the effect and complication of topically applied fibrin glue(Tisseel) on blood loss. Fibrin glue was used to coat the operative site with a fibrin clot to determine the effect on postoperative blood loss. We reviewed 71 cemented total knee arthroplasties from June, 1996 to April, 1998. 71 cases of the total knee arthroplasty was composed of 31 case without fibrin glue(Group I), 12 cases with 5cc fibim glue(Group II) and 28 cases with 10cc fibrin glue(Group III). Hemoglobin and hematocrit were assayed before surgery and 1 day after surgery, and we compared the amount of the total blood loss, autotransfusion in each groups. The average amount of total blood loss is 1362cc(775-2150) in group I,1164cc(505-1670) in Group II, 772 cc(380-1410) in Group III. The average amount of autotransfusion is 72.7%(990cc) of total blood loss in group I, 91.4%(1064cc) in group II, 90%(650cc) in Group III, and Group II & III can autotransfuse above 90% of total blood loss. No significant difference was noted in preoperative and postoperative hemoglobin and hematocrit between each groups. Administration of fibrin glue gives a significant reduction of blood loss, enables autotransfusion about 90% of total blood loss, and provide the advantages of safety from transmission of viral diseases and from immunologic reaction. In conclusion, fibrin glue is a safe and effective hemostatic agent for bleeding control after cemented total knee arthroplasty.
Arthroplasty* ; Blood Transfusion, Autologous ; Fibrin Tissue Adhesive* ; Fibrin* ; Hematocrit ; Hemorrhage* ; Knee* ; Postoperative Hemorrhage ; Suction ; Tourniquets ; Virus Diseases

STUDY DESIGN: Thirteen patients with cervical interlocked facets dislocation in whom closed reduction by skull traction was failed were evaluated about the patterns of ruptured disc fragment. Objects : To evaluate the causes of failure at closed reduction, and the relation between ruptured discs and interlocked facets, and the treatment results through an anterior approach. SUMMARY OF LITERATURE REVIEW: In traumatic dislocation of the cervical facet joints, spinal cord or nerve roots injury associated with the ruptured disc fragment has been reported. However, there is few report evaluating the patterns of ruptured disc fragment as a cause of reduction failure. MATERIALS AND METHODS: Between 1988 and 1997, thirteen patients were treated by anterior fusion with plate after complete removal of the intervertebral disc through anterior approach and reduction of interlocked facets by O1iveira method. They have been followed for an average of 36 months(range : 12-96 months). The interlocking was bilateral in seven cases and unilateral in six cases. We assessed the types of ruptured disc fragment by preoperative MRI and CT and the clinical and radiological results. RESULTS: Ruptured disc fragment was found in all thirteen patients with interlocked facets dislocation. The patterns of ruptured discs were within the uncovertebral joints in 5 cases, posterioly under the posterior longitudinal ligament in 3 cases, anteriorly under intact anterior longitudinal ligament in 3 cases and combined under the anterior and posterior longitudinal ligament in 2 cases. The displacement of ruptured disc fragment were seemed to be the cause of failure in closed reduction. CONCLUSIONS: Intervertebral disc injury should be evaluated carefully with MRI and CT in the lower cervical interlocked facet dislocations before trial of reduction or decision makings of treatment.
Dislocations* ; Humans ; Intervertebral Disc ; Joints ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Skull ; Spinal Cord ; Spine* ; Traction ; Zygapophyseal Joint

No abstract available.
Male ; Penis* ; Xanthogranuloma, Juvenile*

OBJECTIVES: This study was conducted to investigate the effects of aircraft noise exposure on children's mental health problems such as depression and personality. METHODS: We obtained data from the health examinations of school children in the vicinity of Gunsan airport. This survey was conducted in the rural area, Gunsan during 2009. The study population included 195 children attending 4th to 6th grade from 6 elementary schools near the airport. Based on 60 Weighted Equivalent Continuous Perceived Noise Level (WECPNL) measures of aircraft noise, participants were divided into 2 groups; the exposure group consisted of 106 children from 4 schools, and the reference group included 89 children from the 2 schools in Gunsan. All children completed questions on general characteristics, the Korean Children's Depression Inventory (KCDI) for depression, and the Korea Human Nature Inspection (KHNI) for personality. RESULTS: Children in the exposure group were at higher risk of depression (5.62, 95% CI 1.12~28.25), and personality changes (2.08, 95% CI 1.07~4.05) than those of the reference group. In particular, children's diligence, cooperation, and concentration, subgroups of personality measure, were affected significantly and negatively, by aircraft noise level. CONCLUSIONS: Our results suggest that exposure to aircraft noise at school is associated with mental health problems in children. Requirements should be implemented to manage aircraft noise of its affect on children's health.
Aircraft ; Airports ; Child ; Depression ; Health Surveys ; Human Characteristics ; Humans ; Korea ; Mental Health ; Noise

Primary aortoenteric fistulae (AEFs) are extremely rare vascular disease entities, with a mortality ranging from 33 to 85%. Only two cases of Salmonella mycotic aortic aneurysms causing primary AEFs have been reported. We experienced a rare case of a 57-year-old man with intermittent gastrointestinal bleeds and who was diagnosed as having primary aortoenteric fistula with abdominal aortic aneurysm, confirmed by CT. In the operation room, the fistula was closed and a temporary proximal duodenojejunostomy was created. The aneurysm was replaced with an aorto-biiliac bypass using Dacron Graft with an inter-positioning omental flap. The microbiology report of aneurysm wall, blood and periaortic tissue showed infection with group D salmonella. He was treated with ciprofloxacin and discharged in good general condition on the 21st post-operative day.
Aneurysm ; Aortic Aneurysm* ; Aortic Aneurysm, Abdominal ; Ciprofloxacin ; Fistula* ; Humans ; Middle Aged ; Mortality ; Polyethylene Terephthalates ; Salmonella* ; Transplants ; Vascular Diseases

BACKGROUND: Since 1982, many countries has reported outbreaks or sporadic cases caused by enterohaemorrhagic Escherichia coli (EHEC) serogroup strains, mainly E. coli O157:H7 type strain. However, systemic investigation about EHEC agents, including E. coli O157:H7, have not been done in Korea. Therefore, we investigated serogroup and verotoxin productivity of E. coli strains isolated from diarrheal patients and estimated risk of human infection in comparison with the EHEC strains isolated from cow, pig, and food material in Korea. METHODS: Diarrheal patient stool samples were collected and E. coli strains were isolated, according to biochemical characteristics. In order to isolate E. coli O157:H7, D-Sorbitol negative E. coli strains were selected. Serogrouping of the E. coli isolates was done by agglutination test. Verocytotoxin productivity was investigated by polymerase chain reaction (PCR) and reversed passive latex agglutination (RPLA). Human infection risk was estimated in comparison with EHEC strains isolated from cow, pig and food materials in Korea. RESULTS: Twenty-five E. coli strains were isolated from the diarrheal patients who were suspected to be infected with EHEC. However, none of these E. coli strains produced verocytotoxin. Out of 25 E. coli isolates, 16 serogroups of E. coli O1, O6, O8, O15, O20, O25, O26, O28, O29, O44, O86a, O119, O126, O128, O152 and 157:H- were found. In each of the E. coli O157:H- and O25 serogrorps 3 strains were found. CONCLUSION: None of 25 E. coli isolated from diarrheal patients who were suspected of EHEC infection produced verocytotoxin producing E. coli have been reported recently in Korea.
Agglutination ; Agglutination Tests ; Disease Outbreaks ; Efficiency* ; Enterohemorrhagic Escherichia coli ; Escherichia coli* ; Escherichia* ; Humans ; Korea* ; Latex ; Polymerase Chain Reaction ; Shiga Toxins

OBJECTIVE: Efficacy or long-term result of metastasectomy for recurrent or metastatic biliary tract carcinoma (BTC) is not well established. We conducted a retrospective review of the outcomes of metastasectomy for recurrent or metastatic BTCs. METHODS: The clinicopathological features and outcomes of consecutive patients with BTCs who underwent surgical resection for primary and metastatic disease at a tertiary referral hospital from 2003 to 2013 were reviewed retrospectively. RESULTS: We found 19 eligible patients. Median age of patients was 57 years old (range, 27 to 68 years old), and 11 patients (58%) were female. Primary sites were gallbladder cancer (seven patients, 37%), intrahepatic cholangiocarcinoma (five patients, 26%), distal common bile duct cancer (three patients, 16%), proximal common bile duct cancer (two patients, 11%), and ampulla of Vater cancer (two patients, 11%). Eight patients (42%) had synchronous metastasis, while 11 (58%) had metachronous metastasis. The most common metastatic site was liver (nine patients, 47%), lymph node (nine patients, 47%), and peritoneum (three patients, 16%). Nine patients (47%) achieved R0 resection, while four (21%) and six (32%) patients had R1 and R2 resection, respectively. With a median follow-up period of 26.7 months, the estimated median overall survival (OS) was 18.2 months (95% confidence interval [CI], 13.6 to 22.9 months). Lower Eastern Cooperative Oncology Group performance status (P=0.023), metachronous metastasis (P=0.04), absence of lymph node metastasis (P=0.009), lower numbers of metastatic organs (P<0.001), normal postoperative carbohydrate antigen 19-9 level (P=0.034), and time from diagnosis to metastasectomy more than one year (P=0.019) were identified as prognostic factors for a longer OS after metastasectomy. CONCLUSION: For recurrent or metastatic BTCs, metastasectomy can be a viable option for selected patients.
Ampulla of Vater ; Biliary Tract Neoplasms* ; Biliary Tract* ; Cholangiocarcinoma ; Common Bile Duct ; Diagnosis ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Liver ; Lymph Nodes ; Metastasectomy* ; Neoplasm Metastasis ; Peritoneum ; Prognosis ; Retrospective Studies ; Tertiary Care Centers

PURPOSE: To investigate the early results of limited open repair technique of Achilles tendon ruptures, and to describe the surgical technique. MATERIALS AND METHODS: From October 2004 to February 2005, a total of 10 patients with Achilles tendon rupture underwent limited open repair. The average age of the patients was 39.3 years, and the average follow-up period was 9 months. The causes of injury were sports injuries in 8 cases, and slip down in 2. The mean interval between the injury and the operation was 9 days. The clinical results were assessed by patient's satisfaction, incision length, hospitalization, the ankle-hindfoot scale of American Foot and Ankle Society (AOFAS), and complications. RESULTS: Of 10 patients, 8 were very satisfied, and the remaining 2 were satisfied. The mean incision length was 2.0 cm, and the mean hospitalization was 2 days. The mean AOFAS score was 97 points, and there was no complications such as infection, rerupture, or nerve injury. All patients returned to work at approximately 2 months, and resumed light exercise such as jogging at approximately 3 months. CONCLUSION: Limited open repair technique of Achilles tendon ruptures is provided for better cosmetic results, high patient's satisfaction, and functionally successful results without postoperative complications.
Achilles Tendon* ; Ankle ; Athletic Injuries ; Follow-Up Studies ; Foot ; Hospitalization ; Humans ; Jogging ; Postoperative Complications ; Rupture*

Cardiac calcified amorphous tumors (CATs) can arise in all four chambers of the heart. Cardiac CATs can cause diverse symptoms according to their locations, and mass or embolic effects. Pulmonary emboli arising from cardiac CATs have been reported, but the true incidence is unknown due to their rarity. Herein we report a rare case with diffuse CATs in the right ventricle which caused a calcific pulmonary embolism and right-sided heart failure. Echocardiography, chest non-contrast computed tomography, and cardiac magnetic resonance imaging helped us diagnose the CATs. We recommend the usefulness of a multimodality imaging approach to characterize intracardiac masses and their complications accurately.
Animals ; Cats ; Echocardiography ; Heart ; Heart Failure ; Heart Neoplasms ; Heart Ventricles ; Incidence ; Magnetic Resonance Imaging ; Pulmonary Embolism ; Thorax

OBJECTIVES: To determine the level of aircraft noise exposure and how it relates to hearing loss, and to investigate the association between noise exposure and anxiety and depression in subjects residing adjacent to a military airbase. METHODS: The study was conducted upon 898 inhabitants between the ages of 30-79, living near the military airbase in Jeonra-do. The subjects were divided into three noise-exposure groups: high-exposure, low-exposure, and a control group. The cut-values were 80 and 60 on the Weighted Equivalent Continuous Perceived Noise Level scale. A self-administered questionnaire including the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were completed. Pure tone audiometry tests were performed. RESULTS: Hearing loss prevalence was defined by a >40 dB loss in bilateral ears or in one ear; the difference of <15 dB compared to the better side was 30.8%. The mean BAI/BDI score was 18.9+/-14.3/18.7+/-11.6, the number of abnormal subjects with BAIs > or =22 was 317 (35.3%), with BDIs > or =21 was 347 (38.6%). The pure tone average, BAI, and BDI scores were higher in the noise-exposure groups compared to the control. The BAI/BDI abnormal subjects showed a higher hearing threshold shift level compared to the normal scored subjects. The odd ratios for anxiety was significantly high in both noise exposure groups and the hearing loss, for depression was significantly high in high-exposure group and hearing loss. CONCLUSIONS: Anxiety and depression were higher when exposure to high-level noise and further complicated by hearing loss. Further investigation is needed to determine the cause-effect relationship.
Aircraft ; Anxiety ; Audiometry ; Depression ; Ear ; Hearing ; Hearing Loss ; Humans ; Military Personnel ; Noise ; Prevalence ; Questionnaires