PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with those of conventional open plating (COP) for treating comminuted mid-clavicular fractures and to evaluate the usefulness of MIPO. MATERIALS AND METHODS: Thirty-nine patients who underwent surgical treatment for mid-clavicular comminuted fractures were analyzed retrospectively. Nineteen patients were treated with MIPO and twenty patients with COP. Radiological evaluation included time to union, fracture healing, and clavicular length difference measured as the proportional length difference with the unaffected side. Clinical assessment was performed using the simple shoulder test score, American Shoulder and Elbow Surgeons score, and quick disability of the arm, shoulder and hand score. Moreover, the mean operation and radiation times, as well as exposure were compared. RESULTS: All clavicles achieved bone union. The mean time to union was 12.1 weeks in the MIPO group, and 14.6 weeks in the COP group (p=0.587). There was no significant difference between the two groups regarding the functional and radiological outcomes at 2-year follow-up. A significantly shorter operation time was observed in the MIPO group than in the COP group (75.8 min vs. 106.9 min, p=0.002). More radiation time and exposure were identified in the MIPO group (52.8 s vs. 37.1 s, p=0.002; 209.4 mGy vs. 43.1 mGy, p=0.005). CONCLUSION: Both COP and MIPO were shown to be effective treatment options for mid-clavicular comminuted fractures. MIPO may be a better alternative to COP due to shorter operation time and no need for a bone graft, although the functional and radiological outcomes were not significantly different. However, all surgeons should pay close attention to minimize radiation hazard.
Arm ; Clavicle ; Elbow ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Hand ; Humans ; Retrospective Studies ; Shoulder ; Surgeons ; Transplants

OBJECTIVE: To identify the clinical and sonographic parameters which predict the likelihood of successful labor induction in preterm women. METHODS: This prospective observational study enrolled 103 consecutive preterm women (<37 weeks gestation) with singleton gestations scheduled for induction of labor. Transvaginal ultrasound for measurement of the cervical length was performed and the Bishop score was determined by digital examination. The parameters studied were gestational age at induction, parity, maternal age, Bishop score, sonographic cervical length, and current body mass index (BMI). Univariate and multivariate statistical methods were used for data analysis. RESULTS: Successful induction of labor occurred in 45 (44%) of women. Multiple logistic regression analysis identified parity, maternal BMI, and gestational age at induction as the independent predictors of successful labor induction in preterm women, although gestational age did not reach statistical significance (P=0.056). However, maternal age, sonographic cervical length, and Bishop score did not provide independent contribution to success of induction. CONCLUSION: In preterm women undergoing induction of labor parity, maternal BMI, and gestational age at induction were independent parameters in predicting successful induction of labor. However, sonographic cervical length and Bishop score had poor predictive values for success of labor induction.
Body Mass Index ; Female ; Gestational Age ; Humans ; Lipids ; Logistic Models ; Maternal Age ; Parity ; Prospective Studies ; Quaternary Ammonium Compounds ; Statistics as Topic

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.
Abscess/complications/*diagnosis ; Cutaneous Fistula/complications/*diagnosis/radiography/surgery ; Groin ; Humans ; Male ; Middle Aged ; Osteomyelitis/complications/*diagnosis/radiography ; Pelvis/radiography ; *Pubic Bone/surgery ; Urinary Bladder Fistula/complications/*diagnosis/radiography/surgery

PURPOSE: We evaluated the syndesmosis instability associated with Weber type B lateral malleolar fractures. MATERIALS AND METHODS: Eighty one Weber type B lateral malleolar fractures were evaluated and classified according to the radiologic criteria. Syndesmosis instability was checked with a hook test during operation. The radiological and clinical results were assessed. RESULTS: Twenty two cases were associated with a widening of the distal tibiofibular distance. Sixteen (73%) had syndesmosis instability confirmed with a hook test and were fixed with a syndesmotic screw. Eight (66%) out of 12 Wagstaffe fractures were fixed with a syndesmotic screw due to the instability. The distal tibiofibular distance was 7.4+/-2.4 mm, 4.6+/-1.9 mm and 4.9+/-1.9 mm preoperatively, postoperatively, and at the final follow up, respectively. All cases achieved union and good clinical results with more than 85 on the AOFAS score were obtained. CONCLUSION: Weber type B lateral malleolar fractures can be associated with a syndesmosis injury. An intraoperative hook test should be carried out for accurate diagnosis. Considerable attention needs to be paid to Wagsteffe fractures, because of the high probability of combining syndesmosis instability.
Animals ; Ankle ; Follow-Up Studies

Signet ring cell carcinoma of lung is an unique variant of mucin producing adenocarcinoma which is characterized by abundant intracellular mucin accumulation. Only a few cases of primary signet ring cell carcinoma of lung have been reported in the world wide literature. And we have, recently experienced one case of primary signet ring cell carcinoma of lung. A 55 years old man was evaluated for paralysis of lower extremities and was found to have lung cancer in the left upper and lower lobe with pleural, multiple spinal, bone and liver metastases. Signet ring tumor cells were revealed by cytologic examination of pleural fluids. And there were no evidence of signet ring cell carcinoma of other organs. Primary signet ring cell carcinoma of lung seems to have an aggressive behavior and therapeutic modalities could be different from those for signet ring cell carcinomas from other organs. Therefore it is important to separate primary signet ring cell adenocarcinoma of lung from metastatic tumors.
Adenocarcinoma ; Carcinoma, Signet Ring Cell* ; Humans ; Liver ; Lower Extremity ; Lung Neoplasms ; Lung* ; Middle Aged ; Mucins ; Neoplasm Metastasis* ; Paralysis

OBJECTIVE: Pineal parenchymal tumors (PPT) are rare; therefore, only limited clinical data regarding their behavior is available. The aim of this study is to evaluate the pathologic features, clinical behavior, and response to therapy of these tumors. METHODS: Thirteen patients with biopsy-proven PPT were treated from September 1992 to February 2004 in our hospital. Their medical records and radiologic studies were analyzed retrospectively. The tumors were divided into three groups: pineocytoma, pineoblastoma, and mixed pineocytoma-pineoblastoma or PPT with intermediate differentiation. Initial stages were made by spinal magnetic resonance images and cerebrospinal fluid cytology. Magnetic resonance images were used for defining the treatment response of the patients. RESULTS: The patients were divided into 4 pineocytomas, 5 pineoblastomas, and 4 mixed/intermediate PPT. The patients aged from 2 to 77 years. The patients presented with headache, nausea, vomiting, memory and gait disturbances, and impaired vision. Only one patient showed disseminated disease at initial staging. All patients that had surgery showed improvements of hydrocephalus. Two patients showed complete responses to treatment, six showed partial responses, two showed stable diseases, and two showed disease progression. Eleven patients were alive, but two were dead due to disease progression. CONCLUSION: Obtaining a tissue diagnosis in patients with PPT is important. Although our experience is limited, we consider that multimodality therapies including surgical resection, radiotherapy, chemotherapy, and radiosurgery must be considered for better outcome in treating patients with PPT. More experience is necessary to determine the optimal treatments of PPT.
Cerebrospinal Fluid ; Diagnosis ; Disease Progression ; Drug Therapy ; Gait ; Headache ; Humans ; Hydrocephalus ; Medical Records ; Memory ; Nausea ; Pinealoma* ; Radiosurgery ; Radiotherapy ; Retrospective Studies ; Vomiting

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.
Female ; Humans ; Magnetic Field Therapy ; Muscle Contraction ; Pelvic Floor ; Physical Examination ; Prospective Studies ; Quality of Life ; Surveys and Questionnaire ; Spouses ; Urinary Incontinence* ; Urinary Incontinence, Urge

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.
Female ; Humans ; Magnetic Field Therapy ; Muscle Contraction ; Pelvic Floor ; Physical Examination ; Prospective Studies ; Quality of Life ; Surveys and Questionnaire ; Spouses ; Urinary Incontinence* ; Urinary Incontinence, Urge

Paragangliomas are rare tumors of a neural crest origin, and belong to the amine- precursor-uptake decarboxylation (APUD) system. The great majority of paraganglioma are in the adrenal medulla. The majority of extraadrenal sites arise near the adrenal or along the nerve plexuses. Paragangliomas are only occasionally found in the wall of the bladder. Their preoperative diagnosis is suspected from a clinical history and an estimation of catecholamines, or their metabolic by-products, in a twenty-four-hour urine sample. The correct diagnosis is not made in the majority of cases because the tumors are frequently silent with regard to hormonal activity. Therefore, an excretory urogram, arteriography and cystoscopy, including biopsy, are important procedures for their preoperative diagnosis. We report a case of paraganglioma arising in the bladder wall, with brief review of literatures.
Adrenal Medulla ; Angiography ; Biopsy ; Catecholamines ; Cystoscopy ; Decarboxylation ; Diagnosis ; Neural Crest ; Paraganglioma* ; Urinary Bladder*

BACKGROUND: Anesthesia and surgery may exacerbate liver function in patients with pre-existing liver disease so it is important to choose less hepatotoxic anesthetics in patients with chronic liver disease. METHODS: This study was designed to examine the postoperative liver function test in 150 patients after hepatectomy with portal triad clamping through retrospective chart review. Patients were divided into an isoflurane group (group I, n = 56) and a propofol group (group P, n = 57) by used anesthetics for maintaining anesthesia. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, alkaline phosphatase, total bilirubin, albumin, and prothrombin time were checked at preoperation, and postoperatively at 1, 3, 7 and 14 days in the two groups. Indocyanine retention rate (ICG-R15) was measured at preoperation, and postoperatively at 1 and 7 days. RESULTS: AST values increased postoperatively at 1, 3, 7, and 14 days compared with preoperation. ALT values increased postoperatively at 1, 3 and 7 days compared with preoperation and there was difference between group I (443.8 +/- 52.1 U/L) and group P (202.7 +/- 24.7 U/L) at postoperative 1 day. Other values had no significant difference between the two groups. CONCLUSIONS: Though it might need a well controlled study to find the differences in effect between isoflurane and propofol on the postoperative liver function test, we concluded that total intravenous anesthesia using propofol is also one of the safest anesthetic methods for hepatic resection with minimal hepatotoxicity.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, Intravenous ; Anesthetics ; Aspartate Aminotransferases ; Bilirubin ; Constriction* ; Hepatectomy ; Humans ; Isoflurane* ; L-Lactate Dehydrogenase ; Liver Diseases ; Liver Function Tests* ; Liver* ; Propofol* ; Prothrombin Time ; Retrospective Studies