PURPOSE: Generally, aspirin is used as a protective agent against thrombogenic phenomenon after pulmonary valve replacement (PVR) using a bioprosthetic valve. However, the appropriate duration of aspirin use is unclear. We analyzed the impact of postoperative duration of aspirin use on the longevity of bioprosthetic pulmonary valves in patients who underwent repair for congenital heart diseases. METHODS: We retrospectively reviewed the clinical data of 137 patients who underwent PVR using a bioprosthetic valve between January 2000 and December 2003. Among these patients, 89 were included in our study and divided into groups I (≤12 months) and II (>12 months) according to duration of aspirin use. We analyzed echocardiographic data from 9 to 11 years after PVR. Pulmonary vale stenosis and regurgitation were classified as mild, moderate, or severe. RESULTS: The 89 patients consisted of 53 males and 36 females. Their mean age was 14.3±8.9 years (range, 2.6–48 years) and body weight was 37.6±14.7 kg (range, 14–72 kg). The postoperative duration of aspirin use was 7.3±2.9 months in group I and 32.8±28.4 months in group II. However, no significant difference in sex ratio, age, body weight, type of bioprosthetic valve, and number of early redo-PVRs. In the comparison of echocardiographic data about 10 years later, no significant difference in pulmonary valve function was found. The overall freedom rate from redo-PVR at 10 years showed no significant difference (P=0.498). CONCLUSION: Our results indicated no benefit from long-term aspirin medication (>6 months) in patients who underwent PVR with a bioprosthetic valve.
Aspirin* ; Body Weight ; Constriction, Pathologic ; Echocardiography ; Female ; Freedom ; Heart Defects, Congenital* ; Heart Diseases ; Humans ; Longevity* ; Male ; Pulmonary Valve* ; Retrospective Studies ; Sex Ratio

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Presacral teratomas are rare tumors derived from embryonic germ layers. They present mostly in infancy and are extremely rare in adults. Patient with presacral teratoma in adults may be asymptomatic on initial presentation. The symptoms are due to their size, to the compression of pelvic viscera or to their complications. CT or MRI are the important investigations for characterization of the mass, evaluation of its intrapelvic extension and relationship to other structures. The treatment of presacral teratomas is mainly complete surgical resection. We report a case of presacral teratoma in 47-year-old woman with a brief review of the literatures.
Adult* ; Female* ; Germ Layers ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Teratoma* ; Viscera

PURPOSE: To analyze functional and radiological results and early motion after the stable fixation of fractures of the distal radius by using two small fragment plates. MATERIALS AND METHODS: Thirty cases were analyzed clinically and radiographically. Internal fixation was achieved using two 2.7 mm stainless steel small fragment plates on the radial and intermediate columns angled 60 degrees C apart in all cases. For functional evaluation, Green and O'Brien scores were analyzed. For radiological evaluation, volar tilting angle, radial inclination, and ulnar variance were analyzed. Arthroscopy was performed in all cases concomitantly. RESULTS: Functional results were excellent or good in 24 patients (80%) according to the modified system of Green and O' Brien. Radiological analysis showed that volar tilting angle, radial inclination or ulnar variance during the immediate postoperative to bony union period had no significant difference. Complications occurred in two wrists, namely reflex sympathetic dystrophy (1) and delayed union (1) needing an additional palmar plate and a bone graft. No case experienced implant failure or extensor tendinitis. CONCLUSION: Two 2.7 mm small fragment plates fixations provided good stability, and allowed early function. We report a series of 30 fractures treated by this method of internal fixation with satisfactory results.
Arthroscopy ; Humans ; Radius Fractures* ; Radius* ; Reflex Sympathetic Dystrophy ; Stainless Steel ; Tendinopathy ; Transplants ; Palmar Plate ; Wrist

PURPOSE: The purpose of this study is to evaluate the clinical results of wire fixation technique for tibial tubercle osteotomy in total knee arthroplasty. MATERIALS AND METHODS: Twenty-three cases who underwent TKA with tibial tubercle osteotomy and wire fixation technique for the extensile exposure between January, 1982 and April, 2001, were reviewed. Seventeen cases were male and six cases female. The averageperiod of follow-up was 58 months. The average age was 62.3 years (minimal: 38, maximal: 74). Five cases underwent tibial tubercleosteotomy for primary TKA and the preoperative diagnoses were degenerative osteoarthritis in 2 cases, posttraumatic osteoarthritis in 1case and rheumatoid arthritis in 2 cases. Eighteen cases underwent tibial tubercle osteotomy for revision TKA due to the infected TKAin 10 cases and aseptic loosening in 8 cases. Osteotomized tibial tubercle in size of 2x10 cm was achieved by using oscillating saw and curved osteotome from the point of 2 cm distal to the articular surface of proximal tibia to 8 cm below the tibial tubercle. Six holes were drilled with 1 cm distance for 3 wires passage. The tubercle fragment was fixed with 3 wires and the wires were bent around the tibial stemin the medullary canal for passage through tubercle fragment. The passive range of motion was started within one week after the operation. We evaluated the preoperative and postoperative range of motion and the radiologic bony union was assessed by lateral radiograph. The clinical results were assessed by Knee Society Knee Score. RESULTS: The bony union was achieved in twenty-two cases about 13 moths after the operation, and fixation loss was observed in one case. The average range of motion were 70 degrees (5-90 degrees) preoperatively and 80.8 degrees (25-110 degrees) postoperatively. The average clinical knee scores of painand function were 51 (40-57) point, 58 (45-70) point preoperatively and 54 (50-65) point, 65 (54-78) point postoperatively. Two complications were noted with one case of infection and fixation loss due to injury in each. CONCLUSION: Wire fixation for tibial tubercle osteotomy in total knee arthroplasty results in firm fixation of tubercle fragment, therefore it seems to be an useful technique in exposure for total knee arthroplasty.
Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Moths ; Osteoarthritis ; Osteotomy* ; Range of Motion, Articular ; Tibia

PURPOSE: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. MATERIALS AND METHODS: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder's criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. RESULTS: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. CONCLUSION: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.
Acetabulum* ; Allografts* ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Head* ; Hip ; Transplants

PURPOSE: A new method has been devised to determine contact pressures in prosthetic components. A real time analysis of the contact pressure distribution could help fine tuned implant positioning and ligament balancing during Total Knee Arthroplasty. MATERIALS AND METHODS: Posterior cruciate reserving type procedures were done with externally rotated femoral cut. Femorotibial contact pressure was measured in four compartments in both flexion and extension position. A LOAD CELL located beneath the tibial plate changes the contact pressure into electric signal and DP-41S transformed the electric sign into the pressure unit. Adjunctive fine-tuning operation was done to approximate the equilibrium among the four compartments of the tibial plate. RESULTS: Femorotibial contact pressure were distributed between 17.1 N (Newton) to 33.4 N (average 23.6 N). A peak contact pressure was exhibited in the anteromedial compartment in extended knee and in the posterolateral compartment in flexed knee. CONCLUSION: A LOAD CELL electronic transducer technique was introduced. This method was tried to get the balanced equilibrium of contact pressure between Femorotibial components during TKA.
Arthroplasty* ; Knee* ; Ligaments ; Transducers