The Etiology of Acute Stroke with Experience of Repeated Upper Extremity Deep Vein Thrombosis

In stroke patients, upper extremity deep vein thrombosis (UEDVT) is uncommon compared with lower extremity. Unlike the blood stasis in lower extremity, UEDVT has been developed by secondary cause. We reported a case of stroke patient with repeated UEDVT, presenting superficial venous congestion, who was finally diagnosed with pulmonary adenocarcinoma. The cause of stroke was non-bacterial thromboembolism formed at the mitral valve. Our case shows that unexpected UEDVT should be closely evaluated for higher coagulable status such as a malignancy.

Clinical Characteristics in Panic Disorder Patients in Emergency Department / 정신신체의학

Objectives@#：This study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack. @*Methods@#：A retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher’s exact test was used. Collected data was analyzed using R 4.03. @*Results@#：Cardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (χ2 =4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (χ2 =8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%. @*Conclusions@#：The most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.

Acute Cerebral Artery Occlusion by Direct Tumor Embolus

In acute stroke, emboli are mostly composed of thrombi from artery, cardiac chamber, valve and vein. Non-thrombotic emboli are sometimes difficult to identify the origin. According to the increased number of cancer patients, now 10% of stroke patients have a cancer. However, the potential mechanisms of stroke in patients with cancer are various. We presented a case of serious acute arterial occlusion with a tumor embolus, which was revealed by histopathologic analysis of retrieved emboli during mechanical thrombectomy.

Osteochondral Lesion of Humeral Head Associated with Shoulder Internal Impingement: Report of Three Cases / 대한스포츠의학회지

Internal impingement syndrome is characterized by the posterior shoulder pain when the arm is abducted and external rotated, and articular partial rotator cuff tear with posterosuperior labral fraying in throwing athletes. Osteochondral lesion of humeral head as an associated lesion is reported in some cases but, not considered to be a main origin of the symptoms. We found the similar features of osteochondral lesion on humeral head in three cases of internal impingement syndrome irrespective of conservative treatment for over three months and report good results obtained from arthroscopic debridement and microfracturing for these lesions with a review of the literatures.

Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study

PURPOSE: To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition. MATERIALS AND METHODS: Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry. RESULTS: The mean age and body mass index of the patients was 64.5+/-6.2 years and 24.2+/-2.6 kg/m2, respectively. Mean total prostate volume and transitional zone volume were 48.8+/-18.8 ml and 24.2+/-16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery. CONCLUSIONS: Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.

Significance of Clopidogrel Resistance Related to the Stent-Assisted Angioplasty in Patients with Atherosclerotic Cerebrovascular Disease

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.

Changes in Nocturia after Photoselective Vaporization of the Prostate for Patients with Benign Prostatic Hyperplasia

PURPOSE: To investigate changes in nocturia and predictive factors for improvement after photoselective vaporization of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 103 patients who complained of nocturia of > or =2 times per night on baseline frequency-volume chart (FVC) and who underwent PVP were included in this retrospective study. All patients underwent a preoperative evaluation for BPH including multichannel video urodynamics. The efficacy of the PVP was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score (IPSS) and FVC. Subjective and objective improvement of nocturia were defined as a reduction of > or =50% in nocturnal frequency compared with baseline on the IPSS and FVC, respectively. RESULTS: As shown by the IPSS and FVC, nocturia was significantly reduced starting from 1 month after PVP. The percentage of patients with improvement in nocturia was 20.0%, 20.7%, 36.2%, and 27.9% on the IPSS, and 30.1%, 48.6%, 52.2%, and 54.5% on the FVC at 1, 3, 6, and 12 months after PVP, respectively. None of the baseline parameters, including the presence or absence of nocturnal polyuria (NPU), reduced nocturnal bladder capacity (NBC), and detrusor overactivity (DO), were associated with improvement of nocturia. CONCLUSIONS: Nocturnal frequency was significantly reduced from the early postoperative period after PVP. Improvement in nocturia after PVP was not affected by baseline nocturnal frequency, the presence or absence of preoperative NPU, or reduced NBC or DO on baseline urodynamics.

Bone Ingrowth into Harris-Galante Porous-coated Acetabular Cup Retrieved during Revision

Purpose: To investigate the extent of bone ingrowth into the porous-coated acetabular cups as well as the factors that correlated with bone ingrowth in total hip arthroplasty. Materials and Methods: Thirty six Harris-Galante porous-coated acetabular cups that were retrieved through revision surgery were examined in this study. Acetabular cups retrieved due to infection or severely destroyed cups (ed note: severe what?) were excluded. The extent of bone ingrowth into the acetabular cups was grossly measured, and its correlation with the variables including age, gender, weight, height, the duration of fixation, size, number of screws, inclination and anteversion was statistically analyzed. Results: The mean proportion of bone ingrowth was 52.9 21.9%(2~90%) and less than 30% in three cups(8.3%). The pattern and the location of bone ingrowth were not consistent. There was no correlation between the extent of bone ingrowth and age, gender, weight, height, the duration of fixation, cup size, number of screws, size, inclination and anteversion. Conclusion: Harris-Galante porous-coated acetabular cups showed satisfactory bone ingrowth regardless of the variables associated with the demographic or surgical conditions. Surface treatments with a fiber-metal porouscoating appears to be suitable for cementless acetabular cups in terms of the long term results.

Traumatic Carotid-cavernous Fistula Bringing about Intracerebral Hemorrhage

Spontaneous intracerebral hemorrhage associated with traumatic carotid-cavernous fistula is rare. The cardinal symptoms of traumatic carotid-cavernous fistula are confined to ocular manifestations. This article describes a case of traumatic carotid-cavernous fistula which was initially diagnosed as an intracerebral hemorrhage, after ocular symptoms were overlooked. Because some cases of carotid-cavernous fistula have an atypical drainage which can result in intracerebral hemorrhage, early diagnosis and intervention are vital to prevent this unwanted intracerebral hemorrhage.

Recurrent Spontaneous Intracerebral Hemorrhage

OBJECTIVE: Recently, the survival rate and prognosis of spontaneous intracerebral hemorrhage(S-ICH) has improved, and their enhanced survival has become associated with a consequent rise in the recurrence of S-ICH. The aim of this study is to improve the prevention of recurrent S-ICH. METHODS: Between January 1999 and March 2004, we experienced 48 cases of recurrence. We classified the patients into the two groups; a double ICH group and a triple ICH group. We investigated their brain CTs, MRIs, cerebral angiographies, and medical records, retrospectively. RESULTS: Majority of patients had the intervals at least 12 months, and most of patients underwent conservative treatment. The most common hemorrhage pattern of recurrence was ganglionic-ganglionic (basal ganglia-basal ganglia), and the second attack was contralateral side of the first attack in a large percentage of all patients. Prognosis of patients was worsened in recurrent attack. Nearly all patients had medical history of hypertension, and most patients have taken antihypertensive medication at the arrival of emergency room. CONCLUSION: In treating hypertension for S-ICH patients, we stress that blood pressure must be thoroughly controlled over a long period of time.

Clinical study for "focal endosteal osteolysis" around the femoral component in the total hip arthroplasty / 대한정형외과학회잡지

No abstract available.

Reconstruction of lower extremity by fibular free flaps

No abstract available.

Cementless Total Hip Arthroplasty using Anatomically Designed Femoral Components / 대한정형외과학회잡지

PURPOSE: To evaluate the mid and long-term clinical and radiological results of cementless total hip arthroplasty using a stem of anatomic design, and to determine those factors that influence stem loosening. MATERIALS AND METHODS: We analyzed 102 hips (83 patients) managed with cementless total hip arthroplasty using the stem of anatomic design with an average of 6.2 years of follow-up Twelve hips showed radiological loosening of the femoral stem. We compared these 12 hips with 24 well-fixed hips. RESULTS: The Harris hip score was 90.1 an average (range: 70-100) and the incidence of thigh pain was 19.1% (21 hips) at the last followup. The rate of revision was 2.9% (three hips) for the femoral side. Twelve hips (11.7%) showed radiological loosening on the femoral side, namely, subsidence of the stem (five hips), change in the position of the stem (six hips), and extensive osteolysis (one hip). The two groups differed significantly in femur of the wear rate of polyethylene liner, osteolysis, and stem fill. CONCLUSION: Operation involving an anatomic prosthesis should be properly performed to fill the proximal part of femur, and the wear the bearing surface should be improved. Furthermore, the prevention of thigh pain should be considered in the design of anatomic femoral stem.

Vitamin D Resistant Rickets / 대한정형외과학회잡지

The discovery and synthesis of vitamin D and the elucidation of the role of sunlight in the activation of the vitamin D precursors changed the syndromes of rickets from a therapeutic enigma to a socioeconomic and public health problem. Since Albright in 1937 first described vitamin D resistsnt rickets, which did not respond to treatment with the usual dose of vitamin D, it has progressively become a common form of rickets in practice. In addition, as the result of increasing understanding of renal physiology and careful investigation, a spectrum of renal tubular abnormalities have been identified which cause clinical rickets and which in many cases are insensitive to even large doses of vitamin D. We have reported a case of an unusual form of vitamin D resistant rickets which did not easily respond to treatment with high doses of vitamin D and was associated with hypocalcemia in multiple pathologic fractures in the lower extremities of the patient.

The Relationship between Chondromalacia Patellae and Extensor Mechanism of the Knee Joint / 대한정형외과학회잡지

Among previously proposed etiological factors of chondromalacia patellae, abnormality in the extensor mechanism of the knee joint has been attributed as a cause of chondromalacia patellae by many authors Malalignment in the extensor mechanism of the knee joint is supposed to cause the positional change of patella. This positional change of patella can be measured by Q angle and P/PT ratio. Hereby we intened to classify the relationahip between the above measurement lenoting the positional change of patella and chondromalacia patellae. These values were obtained from 60 patients found to have chondromalacia patellae in Han Gang Sacred Heart Hospital, from Jan. 1977 to Sep. 1978. Values were also obtained from 60 normal persons as a control group. Thus a statistical analysis was made for the possible relationship between extensor mechanism of the knee joint and chondromalacia patellae. The following conclusion were made, 1. The sex ratio was 1:1.3 with female preponderance. There was 26 male and 34 female patients, common age group of chondromalacia patellae was age 20-40 years. 2. The average value of Q angle was 11 in control group, while 18 in chondromalacia patellae, having the difference of 7. 3. The average values of Q angle among different sexes were reviewed. The male control group had 9 of average value of Q angle, while male chondromalacia patellae had 16. The female control group had 12 of average value of Q angle, while female chondromalacia patellae had 20. 4. The average value of P/PT ratio was 1.03 in control group, while 0.9 in chondromalacia patellae, having the difference 0.13. For P/PT ratio in different sexes, the average value was 1.01 in male control group. while 0.9 in male chondromalacia patellae. The average value of P/PT ratio was 1.04 in female control group, while 0.89 in female chondromalacia patellae, 5. For statistical survey for these differences, P value was examined by t-test methods. The statistical diffrences of Q angle in male control group and chondromalacia patellae was 3.4 and it was 2.06 in he female. The difference between control group and the chondromalacia patellae in the overall seves was 2.61, thus having statistical significance.

Proximal Migration of the Intramedullary Nail in Fracture of the Femur / 대한정형외과학회잡지

Various devices have been introduced in the field of orthopaedic surgery for the treatment of fractures and dislocations. Widely used among these are metallic nails and pins. A rare complication is the migration of such intermal fixation devices from their original sites of insertion. Examples of migration have been shown in cases for which devices like Kirschner wire and Steinmann pin were used. Acromio-clavicular joint dislocation gives us another good example. Kuntscher nail has beenin worldwide use for the treatment of femoral shaft fractures since the original work of Kuntscher in 1940. Yet few cases were reported, for migration & Kuntscher nail. We, recently had an experience of proximal migration of a Kuntscher nail in a femoral shaft fractnre which was markedly comminuted. The case is presented here with references.

Fracture of the Carpal Navicular / 대한정형외과학회잡지

1. Ten cases of fracture of the carpal navicular were observed and analyzed, which were treated by thumb-including short arm cast in the Department of Orthopedic Surgery, Han Kang Sacred Heart Hospital during the period from November 1, 1977 to May 31, 1978. 2. Of the total ten cases eight cases were between the age of twenty and forty. 3. The sites of fracture were confined to the middle one third in ten cases. The fracture lines were-transverse in six cases. 4. There was little difficulty in confirming the diagnosis initially with clinical symptoms and signs and roentgenologic studies available. But, in one case the frature line was not detected by usual roentgenologic studies including the carpal navicular view. 5. Union was obtained from two cases after ten weeks of cast immobilization, from four cases after twelve weeks and from three cases after twenty weeks. In the remaining one case, however, pain was persistent after twenty-four weeks of immobilization. 6. The results of treatment were excellent in four cases and good in five cases so that nine patients could return to their work.

Hair Strangulation: A Case Report / 대한정형외과학회잡지

A case of hair strangulation on right toe of two months old female patient is reported together with a brief review of references in this paper. This hair strangulation was on the proximal interphanlangeal joint of the right third toe. The distal portion of the hair strangulation was discolored as black, swollon, cold and no evidence of circulation. Amputationon the metatarsophalangeal joint was done.

Replantation of amputated distal phalangeal parts of fingers by using composite graft and subcutaneous pocketing

No abstract available.

Replantation of amputated distal phalangeal parts of fingers by using composite graft and subcutaneous pocketing

No abstract available.