PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.
Automobiles ; Braces ; Decompression ; Diskectomy ; Dislocations* ; Female ; Gait Disorders, Neurologic ; Head ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pneumonia ; Pressure Ulcer ; Radiculopathy ; Skull ; Spine ; Traction ; Zygapophyseal Joint*

No abstract available.
Cushing Syndrome*

PURPOSE:Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor, and stomach is the major site of ghrelin secretion. The purpose of this study is to compare the serum ghrelin concentrations between patients with type 2 diabetes mellitus (DM) and normal adults. We studied also whether serum ghrelin levels in the patients with type 2 DM are correlated with body mass index (BMI), serum insulin, lipid profiles, and creatinine levels. METHODS:Forty patients with type 2 DM and forty normal adults were included in this study. We measured heights and weights of the subjects and calculated their BMIs. Blood samples were obtained to measure the ghrelin concentration and their sera were stored at -20degreeC until used. In all subjects, serum ghrelin levels were measured using the commercially available Ghrelin(human) EIA kit. RESULTS:No differences of mean values were detected between the control group and the type 2 diabetic group for age, body weight, BMI, and the levels of serum total cholesterol, triglyceride, HDL cholesterol, and creatinine. But ghrelin level of the type 2 diabetic group (71.1+/-30.5 ng/L) was significantly lower than the control group (139.7+/-36.9 ng/L). In the control group, the ghrelin level showed positive correlation with HDL cholesterol (Pearson's correlation coefficient=0.37, P<0.05). In the diabetic group, the ghrelin level showed weakly positive correlation with insulin concentration. However, there was no significant relationship between serum ghrelin and various parameters in the diabetic patients group. CONCLUSION: In this study, ghrelin concentration in type 2 diabetic patients was lower than that in the control group. In the control group, serum ghrelin concentrations were positively correlated with HDL cholesterol. In the type 2 diabetic group, there was no significant correlation between insulin and ghrelin concentrations.
Adult ; Body Mass Index ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Ghrelin* ; Humans ; Insulin ; Receptors, Ghrelin ; Stomach ; Triglycerides ; Weights and Measures

We performed a retrospective analysis of the results of surgical treatment of sixteen patient with comminuted fracture of the distal femur from September 1993 to August 1995 and evaluated the efficacy of the angled blade plate as one of the fixation devices used. The fractures were limited to C2 and C3 fracture classifed according to the AO classification. After an average follow-up of 13 months (range, 9 to 24 months), all of the fractures had healed. Postoperatively, the arc of flexion was limited between 90degrees and 125degrees in eight, normal arc in five, and severely restricted arc of joint motion was present unexceptionally in three patients with deep infection. In angular deformity, average 5.8degrees of valgus and 2.4degrees posterior angulation were showed. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 3, good in 7, fair in 3, and poor in 3 cases. The overall results were seen to be excellent to good in ten cases (62.5%) but in twelve patients using the angled blade plate, excellent to good results were showed 10 patients (83.3%). We attribute the favorable results in our series to restoration of the articular surface through the modified extensile approach, sufficient stable fixation using the angled blade plate with conforming to the concept of bridge plate, routinely performing the bone graft for medial buttress and bone healing, and early mobilization of the extremity.
Classification ; Congenital Abnormalities ; Early Ambulation ; Extremities ; Femur* ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Joints ; Retrospective Studies ; Transplants

Dental Occlusion ; Female ; Humans ; Incisor ; Jaw ; Lip ; Male ; Mandible ; Orthodontics ; Orthognathic Surgery ; Reference Values

Background: We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes. Methods: We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome. Results: Although the average distance and travel time from the pregnant women’s residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users’ maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P= 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant. Conclusion The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

Fractures of the tibial pilon are the severe injuries to the ankle joint resulted from axial compression, shear and/or rotational forces. The mangement has been notoriously difficult due to the comminution of the distal tibia, articular incongruity and soft tissue trauma. The advocated treatment sequence of fibular reconstruction, restoration of the articular suface, bone grafting of defects and the use of an anterior or medial neutralization plate, early movement and delayed weight bearing, were performed recently and the best results have been obtained. The results of treatment of 18 cases were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital and Chong ju Lee Rha Hospital from Mar. 1982 to Aug. 1989. The results were as follows. 1. The most frequent type of fracture was type III according to Ruedi and Allgower's classification. 2. The operative treatment was performed with plates and screws in fourteen cases. 3. The overall good and fair results were 72%.
Ankle Joint ; Bone Transplantation ; Classification ; Clinical Study ; Jeollabuk-do ; Orthopedics ; Tibia ; Weight-Bearing

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.
Classification ; Fractures, Comminuted ; Incidence ; Jeollabuk-do ; Neural Tube ; Neurologic Manifestations ; Orthopedics ; Spinal Canal ; Spine

PURPOSE: This study presented the clinical outcomes at a minimum one year following anterior cruciate ligament (ACL) reconstruction using autogenous four-strand hamstring tendon and measured the strength of the knee flexor and extensor after tendon harvest. MATERIALS AND METHODS: Twenty seven patients who had a symptomatic ACL insufficiency underwent ACL reconstruction using four-strand hamstring autograft from Dec. 2003 to Jun. 2004. The patients were evaluated according to clinical findings (Lachman test, pivot shift test), standard knee scales (Lysholm, IKDC), and KT-1000 manual-maximal side-to-side difference. Functional test including one-leg hop test for distance and vertical jump test was performed and the strength of the knee flexor and extensor was measured using Cybex isokinetic test at last follow-up. RESULTS: At the time of follow-up, the average Lysholm score improved from 63.0 preoperatively to 95.0 and overall IKDC evaluation showed 14 patients was graded as A, 13 as B. There were 18 patients (66.6%) in negative Lachman test and also 25 patients (92.6%) in negative pivot shift test. The average KT-1000 manual-maximal side-to-side difference was 2.1+/-1.2 mm. One-leg hop distance and one-leg vertical jump test showed 12.3% and 22.3% decrement than uninvolved side. On isokinetic cybex test, peak extensor torque was 80.0% and 82.7% and peak flexor torque was 91.2% and 89.4% at the angular velocity of 60 degrees and 180 degrees/sec compared to the contralateral leg. CONCLUSION: ACL reconstruction using autogenous four-strands hamstring tendon seems to be a viable option for restoring stability with good clinical result and less donor site morbidity.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Follow-Up Studies ; Humans ; Humulus ; Knee ; Leg ; Tendons* ; Tissue Donors ; Torque ; Weights and Measures

PURPOSE: This study was undertaken to determine the incidence and the meaning of epileptiform discharges accompanied by chronic recurrent headaches. METHODS: We selected 449 cases of children who visited Dong-A University Hospital because of recurrent headaches from January 1999 to July 2005. The headaches were classified by the criteria established by the International Headache Research Committee in 2004. The electroencephalography was performed in 336 cases and 36 cases who showed epileptiform discharges were selected. We studied the characteristics of epileptiform discharges, MRI findings and the relationship with epilepsy. RESULTS: The incidence of interictal epileptiform discharges(ILEDs) of the patients with chronic headaches was 10.7%, which was higher than that in a normal population. In the location of ILEDs, focal areas(9.2%) were more common than general areas(1.5%). The incidence of the ILEDs was different according to the types of headaches(P<0.01). The focal ILEDs were concentrated at the central temporal areas. The most common type of ILEDs was frequent epileptiform discharges(63.9%). For the wave forms of ILEDs, focal spike activities were 83.3%, and bursts of slow waves mixed with spikes were 13.9%. Among the 36 cases that showed the ILEDs, 2 cases were associated with epilepsy and another 2 with AV malformation on the MRI images. CONCLUSION: The ILEDs of the patients with chronic recurrent headaches mainly occurred in the central temporal areas as focal spike wave forms, which shows a benign course. Because a few cases can accompany epilepsy and brain abnormalities, close observation and follow-up tests are needed.
Brain ; Child* ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Headache Disorders ; Headache* ; Humans ; Incidence ; Magnetic Resonance Imaging