Objective: : To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. Methods: : The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. Results: : In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. Conclusion : The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians’ experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

Purpose: This study assessed the results of surgical treatment for Neer type-II and type-V unstable distal clavicle fractures via hybrid fixation with a locking compression plate and finger trap wire. Materials and Methods: From September 2016 to April 2018, 15 patients treated for Neer type-II and type-V unstable distal clavicle fractures using hybrid fixation were analyzed retrospectively. The clinical results were analyzed based on the radiological healing time, range of motion of the shoulder joint, American Shoulder and Elbow Society (ASES) score, and the University of California at Los Angeles (UCLA) shoulder score. Results: The range of motion of the shoulder joint completely recovered to the normal range within 9.2 weeks on average (6−24 weeks). Furthermore, the follow-up of the clinical trial showed excellent results, including an ASES score of 98.5±2.3 and an UCLA score of 34.2±1.3. In addition, fracture union was successfully achieved in all cases, and was identified during week 15 on average. Conclusion For the treatment of unstable distal clavicle fractures, hybrid fixation is a useful surgical method with excellent clinical outcomes through rapid recovery of the range of motion of the shoulder joint after surgery.

PURPOSE: We evaluated the clinical outcomes of the autologous platelet rich plasma injection for the treatment of recalcitrant medial and lateral epicondylitis. MATERIALS AND METHODS: Nineteen cases with recalcitrant medial and lateral epicondylitis despite of conservative treatment for 1 year were enrolled in this study. Each patient underwent autologous platelet rich plasma injection and followed up minimally of 40 weeks. The assessment included a preoperative and postoperative Visual Analogue Scale (VAS) (0~10) at 4, 8, 12, 24 and 36 weeks and overall satisfaction was evaluated with Roles & Maudsley score at 36 weeks after injection. We also compared the clinical outcomes between medial and lateral epicondylitis group. RESULTS: Mean preoperative VAS was 8.7 points and improved to 5.1, 5.2 and 4.7 at 12, 24 and 36 weeks follow up, respectively. Roles & Maudsley score was excellent in 5 cases(26%), good in 7 cases(37%), acceptable in 4 cases(21%) and poor in 3 cases(16%). On the comparison of medial and lateral epicondylitis group, there was no statistical significant difference (p=0.38). CONCLUSION: The autologous platelet rich plasma injection for recalcitrant medial & lateral epicondylitis is thought to be a alternative treatment option.
Blood Platelets ; Elbow ; Follow-Up Studies ; Humans ; Platelet-Rich Plasma

PURPOSE: We wanted to review the clinical results of staged reimplantation in patients who had candidal infection after total knee arthroplasty. MATERIALS AND METHODS: We reviewed five patients who had a candidal prosthetic knee infection, as was assessed by synovial fluid culture. Amphotericin B was intravenously administrated to all five patients during the postoperative period for six weeks and followed for at least twelve months. We carried out two-stage re-implantations with using antifungal agent-impregnated bone cement. Whether or not infection recurred was evaluated according to the symptoms and radiologic and hematologic studies. The clinical results were analyzed on the basis of the range of motion and hospital for special surgery (HSS) score. RESULTS: The final review showed that all of the symptoms disappeared. We could not find any loosening on the radiologic studies and all five patients had normal C-reactive protein values on serological exams. The mean postoperative range of motion was 1degrees (range: 0~5)~99degrees (range: 70~130) and the mean HSS score improved from 49.4 (range: 44~64) points to 73 (range: 65~90) after the re-implantation. CONCLUSION: We successfully controlled five candidal prosthetic knee infections by removing the components in conjunction with using an antifungal- impregnated bone cement and staged re-implantation after a 6 week course of intravenous antifungal drugs.
Amphotericin B ; Arthroplasty ; C-Reactive Protein ; Candida ; Humans ; Knee ; Postoperative Period ; Range of Motion, Articular ; Replantation ; Synovial Fluid

A case of the comminuted fracture of the femoral shaft with osteoporosis is presented. The patient lacked sufficient bony stability and cortical bone-contact which allows union by conventional reconstruction method. Therefore, the authors performed a technique utilizing an intramedullary plate in combination with the standard lateral plate in order to obtain bony stabilization, early range of motion of the knee, and partial weight bearing ambulation and the technique is introduced.
Femur ; Fractures, Comminuted* ; Humans ; Knee ; Methods ; Osteoporosis ; Range of Motion, Articular ; Walking ; Weight-Bearing

A case of the comminuted fracture of the femoral shaft with osteoporosis is presented. The patient lacked sufficient bony stability and cortical bone-contact which allows union by conventional reconstruction method. Therefore, the authors performed a technique utilizing an intramedullary plate in combination with the standard lateral plate in order to obtain bony stabilization, early range of motion of the knee, and partial weight bearing ambulation and the technique is introduced.
Femur ; Fractures, Comminuted* ; Humans ; Knee ; Methods ; Osteoporosis ; Range of Motion, Articular ; Walking ; Weight-Bearing

PURPOSE: We analyzed the correlation of the Lysholm score, anterior displacement of tibia on stress radiography and muscle strength around the knee with postural control after anterior cruciate ligament reconstruction and also compared them with the normal subjects. MATERIALS AND METHODS: Twenty-five patients after ACL reconstruction were evaluated with Lysholm knee score, anterior displacement on stress radiography with Telos, muscle strength around the knee with Biodex dynamometer and postural control with posturography. RESULTS: The postural control had significant correlation with the Lysholm knee score & anterior displacement on stress radiography(r=0.565, r=0.783, p<0.01), but not with muscle strength around the knee(p>0.05). Patients group with 5mm instability under anterior displacement on stress radiography showed no significance compared with normal control group, while the group with instability more than 6mm showed significant differences in some conditions com- pared with control group. CONCLUSION: Postural control after ACL reconstruction have significant correlation with Lysholm score and we presumed that the acquisition of mechanical stability of the knee after ACL reconstruction may be one of the important factors associated with the recovery of postural control by improvement of the proprioception.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Humans ; Knee ; Muscle Strength ; Proprioception ; Radiography ; Tibia

PURPOSE: To investigate the improvement in balance after TKA and the difference of balance between posterior cruciate ligament retaining & posterior cruciate ligament substituting prostheses. MATERIALS AND METHODS: Twenty-six patients scheduled to undergo TKA were randomly assigned to receive either PCL-retaining or PCL-substituting prosthesis. The balance of the subjects were checked prior to and at least six months after the operation by computerized dynamic posturography. We investigated whether the balance improve and the difference of change between the implants. RESULTS: Patients showed significantly the improvement of balance by the knee proprioception after TKA (p<0.05) during intercepting visual compensation and the more HSS Knee score improve, the more its balance improve (p<0.05, r=0.667). But the difference of balance between the implants was not detected significantly (p>0.05). CONCLUSION: The balance by the proprioception improves as the HSS Knee Score increases after TKA, and does not show the difference between the implants.
Compensation and Redress ; Humans ; Knee ; Posterior Cruciate Ligament ; Proprioception ; Prostheses and Implants

It is known that most of the extrahepatic metastasis of hepatocellular carcinoma occurs through the blood stream and the most frequent target organ is the lung. Intraperitoneal metastasis via the lymphatics is rare (2~16%) and this has been largely demonstrated by laparosopy or on the autopsy findings. Especially, omental metastasis of hepatocellular carcinoma has only been rarely reported on. A 62-year-old male patient who underwent TACE for hepatocellular carcinoma was admitted for an emergency operation for hemoperitoneum. On the operative findings, there were two 1.5 by 3 cm-sized masses in the omentum and one of them was ruptured and bleeding. The masses were diagnosed as metastatic hepatocellular carcinoma on the pathologic examination. The patient recovered and is being followed.
Autopsy ; Carcinoma, Hepatocellular* ; Emergencies ; Hemoperitoneum* ; Hemorrhage ; Humans ; Lung ; Male ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Rivers ; Rupture, Spontaneous*

PURPOSE: We evaluated the effect of nerve decompression for restoration of plantar sweating and sensation in diabetic neuropathic feet, and we selected diabetic neuropathic patients with the possibility of overlying entrapmental neuropathy. MATERIALS AND METHODS: From June 2002 to May 2003, we have investigated and follow-up examed 10 patients with diabetic neuropathic feet, with decreased sensation in their lower limb, who underwent peripheral nerve decompression. The surgical procedure was multiple neurolysis of the common peroneal nerve, posterior tibial nerve and its three branches of one limb. We compared the operated limb with the opposite, unoperated limb. We performed history taking, physical examination, sweat secretion test, touch sensory test using Semmes-Weinstein monofilaments and electrodiagnostic study, pre-operatively and post-operatively. RESULTS: On 6 months after the operation, the post-operative tests showed that there were noticeable improvements to sensation, statistically (P<0.05), but there was no change in the sweat secretion test. According to the Cseuz criteria, 7 patients out of the 10 patients who received the multiple neurolysis showed excellent or good results. CONCLUSION: We observed that the peripheral nerve neurolysis could be benefit for improving sensation and alleviating pain of the diabetic neuropathic feet with nerve entrapmental symptoms, but there was no change in the sweat secretion on short-term follow-up. To identify whether the effect will be continued or not, additional follow-up will be required.
Decompression ; Diabetic Foot* ; Extremities ; Follow-Up Studies ; Foot ; Humans ; Lower Extremity ; Nerve Compression Syndromes ; Peripheral Nerves ; Peroneal Nerve ; Physical Examination ; Sensation ; Sweat ; Sweating ; Tibial Nerve