Background: Various implants are used to treat intertrochanteric fractures. However, the optimal implant to stabilize intertrochanteric femoral fractures is still a matter of debate. The purpose of the present study was to evaluate the midterm outcomes of patients treated using compression hip nails (CHNs). Methods: Between March 2013 and April 2018, 164 patients with intertrochanteric femoral fractures who were treated with internal fixation using CHNs were enrolled in this study. The mean age of the patients was 79.6 years. We retrospectively collected and estimated information such as reduction state, implant position, operation time, blood loss, hospital stay, time to achieve union, clinical scores (Harris hip score [HHS] and EuroQol five-dimensional [EQ-5D]), intraoperative complications (such as lag jamming and drill bit breakage), failure of fixation, avascular necrosis, and surgical site infection. Results: The mean follow-up period was 39.69 months. Eight percent of the patients required an open reduction. The mean operation time was 131 minutes, the mean blood loss was 221.19 mL, the mean hospital stay was 20.66 days, and the average time to union was 18 weeks. Intraoperative complications included 8 cases of breakage of the drill bit while making distal holes. The failure rate was 3.7% and revision surgery was performed in 6 cases (for cut-out in 5 and pull-out of the lag screw in 1). Asymptomatic venous thromboembolism occurred in 2 cases and hematoma requiring intervention occurred in 1 case. There were no other complications such as avascular necrosis, infection, and lateral irritation. At the 2-year follow-up, the averages of HHS and EQ-5D were 71.54 and 0.68, respectively. Conclusions Among the implants used to treat intertrochanteric femoral fractures, CHNs had a surgical failure of 3.7% and showed good radiologic and clinical results.

Objective: The air pollution on pregnancy outcome (APPO) study is a prospective hospital-based cohort study designed to investigate the maternal and fetal effects of a particulate matter with an aerodynamic below 10 μm (PM10) and PM2.5 (below 2.5 μm) exposure. This study aims to analyze a relationship between particulate matter and adverse pregnancy outcomes and to find related biomarkers and develop management guidelines. Methods: About 1,200 pregnant women are recruited for 3 years (from January 2021 to December 2023) from seven university hospitals to investigate the effects of particulate matter on pregnancy complications and adverse pregnancy outcomes. We collect biological samples by 5 mL of maternal venous blood and 15 mL of urine in each trimester of pregnancy, and 5 mL of umbilical cord blood and 2×2×2 cm of placental tissue are collected after delivery. In addition, by applying PM10 and PM2.5 concentration values and time-activity patterns from the time weighted average model, the individual predicted exposure of air pollution for the pregnant women are obtained. Results: The average exposure of PM10 and PM2.5 of the participants in the entire period of pregnancy, was exceeded the World Health Organization air quality guidelines (an annual level, PM10 >15 μg/m3, PM2.5 >5 μg/m3). Moreover, it was revealed that the PM concentration was increasing toward the 3rd trimester of pregnancy. Conclusion The APPO study will be able to identify the degree of exposure to air pollution in pregnant women and use it as basic data for estimating individual exposure to particulate matter. And the results of the APPO study will facilitate in the development of health management for pregnant women against air pollution.

STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

STUDY DESIGN: To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. OBJECTIVES: We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion. MATERIALS AND METHODS: We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement. RESULTS: The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically. CONCLUSIONS: Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.
Head ; Humans ; Incidence ; Joints ; Retrospective Studies ; Zygapophyseal Joint

Femoral artery pseudoaneurysm (FAP) is one of the most troublesome groin complications related to femoral arterial access during invasive cardiovascular procedures. Ultrasound-guided compression is the initial treatment for FAP. Here, we describe the case of a 65 year-old female who developed significant deep vein thrombosis (DVT) following ultrasound-guided compression of FAP after percutaneous coronary intervention. She was successfully treated with anti-coagulation medications. This case, along with a brief review of the literature, should remind physicians of the possible occurrence of delayed vascular complications, such as DVT, after ultrasound-guided compression of FAP.
Aged ; Aneurysm, False* ; Female ; Femoral Artery ; Groin ; Humans ; Percutaneous Coronary Intervention ; Venous Thrombosis*

Langerhans cell histiocytosis (LCH) is a rare disease of the monocyte-macrophage system involving clonal proliferation of Langerhans cells. Central nervous system (CNS) involvement of LCH occurs in 10-57% of all LCH cases. This disease is known to present in two ways in the CNS: intracranial tumorous lesions or intracranial nontumorous lesions (neurodegeneration). We report here an LCH patient who developed gait disturbance and dysarthria due to neurodegenerative lesions associated with LCH.
Central Nervous System ; Dysarthria ; Gait ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Rare Diseases

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.
Antibodies, Monoclonal, Humanized ; Breast ; Breast Neoplasms ; Estrogens ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Trastuzumab

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.
Antibodies, Monoclonal, Humanized ; Breast ; Breast Neoplasms ; Estrogens ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Trastuzumab

PURPOSE: To evaluate the incidence, causative organism, clinical features, and visual outcomes of acute endophthalmitis following intravitreal injection. METHODS: For all intravitreal triamcinolone acetonide, bevacizumab, and lucentis injections performed in our outpatient clinic between January 2006 and June 2008, the number of injections, indications, type of administered drugs, and method of injection were investigated. The medical records of the patients with acute endoththalmitis were reviewed retrospectively. RESULTS: The total number of intravitreal injections was 10,153. The incidence of acute endophthalmitis for all intravitreal injections was 0.020% (2/10,153) with 0.030% (1/3,383) for the triamcinolone acetonide, 0.015% (1/6,552) for the bevacizumab, and 0.000% (0/218) for the ranibizumab drug injections. Streptococcus species were confirmed in the bacterial culture of two eyes with acute endotphthalmitis. After early vitrectomy and intravitreal antibiotics injection, one eye maintained vision but the other eye developed phthisis. CONCLUSIONS: Although the incidence of acute endophthalmitis following intravitreal injections performed in outpatient clinics is very low, due to the potentially fatal visual outcome after endophthalmitis, careful attention to aseptic injection technique is mandatory.
Ambulatory Care Facilities ; Anti-Bacterial Agents ; Antibodies, Monoclonal, Humanized ; Endophthalmitis ; Eye ; Humans ; Incidence ; Intravitreal Injections ; Medical Records ; Retrospective Studies ; Streptococcus ; Triamcinolone Acetonide ; Vision, Ocular ; Vitrectomy ; Bevacizumab ; Ranibizumab

PURPOSE: To evaluate the response rates, toxicitiesy, and survival rates, to vinorelbine (Navelbine(R)), cisplatin and ifosfamide combination chemotherapy, of the patients with inoperable NSCLC (stage III and IV), who received vinorelbine (Navelbine(R)), cisplatin, ifosfamide combinationthe mentioned chemotherapy every 4 weeks. MATERIALS AND METHODS: This study included 26 patients with inoperable NSCLC (stage III and IV), who attended St. Vincent's Hospital Bbetween April 1999 and December 2001, 26 patients were included at St.Vincent's Hospital. The chemotherapy regimen consisted of vinorelbine (25 mg/m2 on days 1 and 8), ifosfamide (1,500 mg/m2 on days 1- and 2 with mesna), and cisplatin (30 mg/m2 on days 1- to 3). The cycles were administered every 4 weeks. A 25% reduction in the doses reduction was applied into subsequent courses if there werewas grade 3~4 neutropenia. RESULTS: The median age was 63 (range, 44~73) years and the male : to female ratio was 19 : 7. One patient had stage IIIa, 6 had stage IIIb and 19 had stage IV. Twenty two patients had an ECOG performance status of 0 or 1, andwith 4 hadhave one of 2. Eighteen of the patients had adenocarcinoma, 7 had squamous cell carcinomas, and 1 had an undifferentiated NSCLC. Two patients were innot able to be evaluatedble due to follow-up loss. Among Of the 24 patients able to be evaluatedble patients, 1 patient had a complete response and 9 patients hada partial responses, and thewith an overall response rate wasof 41.7%. During a total of 104 cycles, grade 3 neutropenia occurred in 29%, grade 4 neutropenia in 12%, grade 3~4 thrombocytopenia in 4%, grade 3 anemia in 11%, and grade 3~4 mucositis in 2%. The mean time to progression was 6.4 months (range 1~13) and the median overall survival was 10 months (range 1.5~32). CONCLUSION: The combination of vinorelbine, ifosfamide and cisplatin, in the dose and schedule employed in this study, shows an response rate of 41.7%, but, because grade 3- or 4 neutropenia occurred in 41%, a careful investigation is needed.
Adenocarcinoma ; Anemia ; Appointments and Schedules ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Follow-Up Studies ; Humans ; Ifosfamide* ; Lung Neoplasms* ; Lung* ; Male ; Mucositis ; Neutropenia ; Survival Rate ; Thrombocytopenia