The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition / 대한중환자의학회지

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition / 대한구급학회지

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Reexpansion Pulmonary Edema after Initial Treatment of Primary Spontaneous Pneumothorax: Small Bore Catheterization versus Chest Tube Thoracostomy

PURPOSE: Reexpansion pulmonary edema (REPE) is a rare but potentially lethal complication of treatment for pneumothorax. This study was designed to compare the frequency of REPE after treatment of primary spontaneous pneumothorax (PSP) with 6 French (Fr) small bore catheterization and 14-20 Fr chest tube thoracostomy. METHODS: The medical records of PSP patients treated with thoracostomy from January 2010 to May 2015 were reviewed retrospectively. We compared the group treated using a 6 Fr small bore catheter with the group treated using a 14-20 Fr chest tube for clinical and demographic factors. The main outcome was the frequency of REPE between the two groups. RESULTS: A total of 196 patients were enrolled. No significant differences in catheter indwelling time, lengths of hospital stay, and treatment failures were observed between the two groups. REPE developed in 21 patients (10.7%). The frequencies of REPE after 6 Fr small bore catheter and 14-20 Fr chest tube were 6.0% (7 of 114 patients) and 17.1% (14 of 82 patients), respectively (p=0.015). In logistic regression analysis, drainage via 14-20 Fr chest tube showed significant correlation with the occurrence of REPE (odds ratio=3.03, p=0.038). CONCLUSION: A 6 Fr small bore catheter offers a safe and effective alternative to a chest tube for treatment of pneumothorax. We suggest that drainage via a small bore catheter should be considered as the initial treatment of choice for PSP patients in terms of frequency of development REPE.

Analysis of Factors Related to Delayed Answer in Interhospital Transfer Refer

PURPOSE: The purpose of this study is to determine the factors related to delayed answer in interhospital transfer in order to reduce the time required to determine interhospital transfer and to provide optimal care for emergency patients. METHODS: This was a retrospective observational study. Data on request for interhospital transfer of emergency patients were collected from July, 2013 to October, 2013 in an urban emergency department with approximately 40,000 annual visits. Time required for determination, receptionist's department and position, decision maker's department and position, patient's general characteristics, and requesting hospital's characteristics were collected. The SPSS package with Student's t-test, Chi-square, one-way ANOVA, and multivariate logistic regression analysis was used for analysis of the data. RESULTS: When the decision maker's department was emergency medicine, the time required to determine inter-hospital transfer was shortest (p<0.001), and position of emergency medicine member was non-significant (p=0.109). When the decision maker's department was non-emergency medicine, specialist had a shorter time required to determine interhospital transfer than resident (p<0.001), but influence of the position of receptionist was non-significant. CONCLUSION: Decision maker for interhospital transfer request should be an emergency medicine member. If one cannot make a decision, one should consult a specialist, not a resident. Hospitals should implement an organized system to shorten the time for interhospital transfer.

An Association between the Inflammatory Marker and Short-term Risk of Stroke in Patients with Transient Ischemic Attack and Low ABCD2 Score

PURPOSE: A transient ischemic attack (TIA) is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral ischemia and short-term risk of stroke after TIA is high. Inflammatory markers play an important role in acute brain ischemia. The purpose of this study was to investigate the association between the inflammatory markers and short-term risk of stroke in patients with TIA and low ABCD2 score. METHODS: The authors conducted a retrospective study of patients diagnosed with TIA in the emergency department (ED) from June 2006 to April 2013. A total of 282 patients diagnosed as TIA with low ABCD2 score were enrolled. Patients were divided into two groups according to occurrence of stroke within 90 days. We analyzed demographic characteristics, laboratory data, and comorbidities of each group. RESULTS: The median age of patients was 50.0(45.8-58.0) years, with 44.3% males. Based on the occurrence of stroke within 90 days, the patients were divided into 42 patients with stroke and 240 patients with non-stroke. Patients with stroke showed a high median age (p=0.027), white blood cell count (p=0.031), neutrophil to lymphocyte ratio (NLR) (p=0.033), C-reactive protein (p=0.005), and glucose (p=0.010). Results of multivariate analysis showed that NLR was a significant predictor of short-term prognosis (odds ratio 2.785, 95% confidence interval 1.453-5,340). CONCLUSION: NLR in the ED may be used as a rapid and easy to measure inflammatory marker for prediction of short-term prognosis in patients with transient ischemic attack and low ABCD2 score.

An Association between the Inflammatory Marker and Short-term Risk of Stroke in Patients with Transient Ischemic Attack and Low ABCD2 Score

PURPOSE: A transient ischemic attack (TIA) is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral ischemia and short-term risk of stroke after TIA is high. Inflammatory markers play an important role in acute brain ischemia. The purpose of this study was to investigate the association between the inflammatory markers and short-term risk of stroke in patients with TIA and low ABCD2 score. METHODS: The authors conducted a retrospective study of patients diagnosed with TIA in the emergency department (ED) from June 2006 to April 2013. A total of 282 patients diagnosed as TIA with low ABCD2 score were enrolled. Patients were divided into two groups according to occurrence of stroke within 90 days. We analyzed demographic characteristics, laboratory data, and comorbidities of each group. RESULTS: The median age of patients was 50.0(45.8-58.0) years, with 44.3% males. Based on the occurrence of stroke within 90 days, the patients were divided into 42 patients with stroke and 240 patients with non-stroke. Patients with stroke showed a high median age (p=0.027), white blood cell count (p=0.031), neutrophil to lymphocyte ratio (NLR) (p=0.033), C-reactive protein (p=0.005), and glucose (p=0.010). Results of multivariate analysis showed that NLR was a significant predictor of short-term prognosis (odds ratio 2.785, 95% confidence interval 1.453-5,340). CONCLUSION: NLR in the ED may be used as a rapid and easy to measure inflammatory marker for prediction of short-term prognosis in patients with transient ischemic attack and low ABCD2 score.

Protective effects of pine bark extract against cisplatin-induced hepatotoxicity and oxidative stress in rats / 한국실험동물학회지

We investigated the protective effects of pine bark extract (pycnogenol(R), PYC) against cisplatin-induced hepatotoxicity and oxidative stress in rats. Twenty-four male rats were divided into the following four groups: (1) vehicle control, (2) cisplatin (7.5 mg/kg), (3) cisplatin & PYC 10 (10 mg/kg/day), and (4) cisplatin & PYC 20 (20 mg/kg/day). A single intraperitoneal injection of cisplatin induced hepatotoxicity, as evidenced by an increase in serum aminotransferase and histopathological alterations, including degeneration/necrosis of hepatocytes, vacuolation, and sinusoidal dilation. In addition, an increase in the malondialdehyde (MDA) concentration and a decrease in the reduced glutathione (GSH) content and catalase (CAT), superoxide dismutase (SOD), and glutathione S-transferase (GST) activities were observed in the cisplatin-treated rat hepatic tissues. In contrast, PYC treatment effectively prevented cisplatin-induced hepatotoxicity, including the elevation of aminotransferase and histopathological lesions, in a dosedependent manner. Moreover, PYC treatment also induced antioxidant activity by decreasing MDA level and increasing GSH content and SOD and GST activities in liver tissues. These results indicate that PYC has a protective effect against acute hepatotoxicity induced by cisplatin in rats, and that the protective effects of PYC may be due to inhibiting lipid peroxidation and increasing antioxidant activity.

An Association Between the Prolonged Heart Rate-corrected QT Interval and Global Functional Outcome in Patients with Subarachnoid Hemorrhage

PURPOSE: Autonomic dysfunctions after subarachnoid hemorrhage (SAH) may lead to various arrhythmias, electrocardiographic abnormalities, and myocardial dysfunction. Prolongation of the heart rate-corrected QT (QTc) interval is frequently observed in patients with SAH. The aim of this study was to examine the associations between the QTc interval and global functional outcome in patients with SAH. METHODS: We studied 413 adult patients admitted via the emergency department within 48 hours after the onset of spontaneous SAH from January 2007 to December 2011. Among 413 patients with SAH, there were 154 male and 258 female patients whose mean age was 58.8+/-12.4 years. QT intervals were measured by standard 12-lead electrocardiography (ECG) and corrected by Bazett formulae. The QTc interval were considered prolonged at >450 ms in men and >470 ms in women. Outcomes were assessed using the length of hospital stay and the Modified Rankin scale (MRS) at discharge. RESULTS: One or more repolarization abnormalities occurred in 61.9% of patients. The most frequently observed ECG abnormality was QTc prolongation (54.9%), followed by non-specific ST-T changes(16.2%), ST-depression(9.2%), T-wave inversion(11.4%), U-wave(2.7%), and ST-segment elevation(1.7%). No correlations were found between age, sex, body mass index (BMI), location of aneurysm, and QTc interval. Multiple logistic regression analysis showed a relationship between prolonged QTc and Hunt Hess grades (p=0.012) in men, length of hospital stay (p=0.038) in women, Fisher grade (p=0.001), and MRS (p=0.006, p=0.011) in both. CONCLUSION: The prolonged QTc interval is more frequently observed in patients with severe hemorrhage and an unfavorable functional outcome (MRS 4-6) in SAH patients.

Representations of Cardiopulmonary Resuscitation on Korean Medical Dramas: Fiction Versus Reality

PURPOSE: We evaluated the differences between the clinical characteristics, procedure and results of real life cardiopulmonary resuscitation versus how CPR is portrayed in Korean medical dramas. METHODS: We watched 58 episodes of Korean television medical dramas including , and , broadcast during the period 2007 to 2010. We identified all occurrences of CPR in each episode and collected the fictional patients' age, sex, location, presumed cause of cardiac arrest, and return of spontaneous circulation rate for the CPR performed, and then compared these with actual, published resuscitation statistics. Whether or not the procedure employed in a fictional CPR scene adhered to current CPR guidelines was also evaluated. RESULTS: There were 39 occurrences of CPR in the 58 television episodes viewed, with the most common cause being cardiac arrest. The fictional ROSC rate after CPR (71.8%) differed significantly from published real life figures (p=0.072). The resuscitation process did not appear to follow current guidelines in 64.1% of the cases. Contrary to reality, the average age of patients was 41.3 years. CONCLUSION: The CPR provided to fictional patients in medical dramas televised in Korea is generally different than what would be provided to a patient in reality. In addition, the ROSC rate appears higher on television than what can be expected in the real world.

A Rare but Fatal Instance of Gastrointestinal Bleeding: Primary Aortoenteric Fistula

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of gastrointestinal bleeding. The diagnosis of PAEF is difficult to make. The classic triad of symptoms, i.e. gastrointestinal bleeding, abdominal pain, and a pulsating abdominal mass is overemphasized, as it occurs in less than 11~25% of the patients. For two thirds of the patients, the diagnosis is made in the operating room. Endoscopic and radiographic studies are very helpful, but the absence of abnormalities can not exclude the diagnosis. PAEF is a clinical and surgical challenge associated with high mortality. A high index of suspicion, early diagnosis and prompt and appropriate surgical intervention are essential to patient survival. Two primary aortoenteric fistulas (aortoduodenal and aortoesophageal) cases are presented and the related literature are reviewed.

Biochemical Markers (Multimarker Index) in the Diagnosis of Acute Cerebral Infarction with a Combination of Usability Tests: A Prospective Randomized Controlled Study

PURPOSE: We examined the utility of biochemical markers in the diagnosis of acute cerebral infarction and the relationship between panel results and the extent and severity of the infarct. METHODS: Group-wise comparisons were made between a group (Group 1) consisting of 38 subjects who were shown through medical screening between April 2007 and March 2008 to have no past history of cerebral disorders and a group (Group 2) consisting of 55 subjects who had visited the ER (during the same period) within 24 hours after the onset of neurologic symptoms and who were diagnosed with stroke through magnetic resonance imaging. Tests were carried out using the Multimarker Index, which is based on the principle of immunofluorescence. B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100beta were examined, and the Multimarker Index (MMX) was derived. The extent of the infarct lesion was assessed using a volumetry program. RESULTS: The average MMX value was 2.27 in group I and 4.14 in group II, and the difference was statistically significant (p<0.05). For group II, the MMX value had a statistically significant correlation with both the extent of infarct lesion (r=0.46, p<0.001) and its severity (r=0.39, p<0.001). CONCLUSION: We believe that biomarker tests using the MMX should provide useful data in diagnosing strokes, and be of utility in making decisions regarding additional diagnostic tests and early treatment.

Internal Fixation of Proximal Humerus Fracture with Locking Compression Plate

PURPOSE: We assessed the radiographic and clinical results of one surgeon's experience treating proximal humerus fractures with a locked proximal humeral plate. MATERIALS AND METHODS: Twenty patients with unstable proximal humerus fractures were treated with a locking compression plate between February 2005 and September 2007. The average age of the patients was 60.6 years, and the average postoperative follow-up period was 22.3 months. The clinical results were evaluated using the Constant and DASH scores. The radiologic results were evaluated by the Paavolainen method, which measures the neck shaft angle and humeral head height. RESULTS: At the last follow-up examination, the mean Constant score was 75.3 and 15 cases (75%) had excellent or good results; the mean DASH score was 16.4. The mean neck shaft angle was 137.1degrees , and 19 cases (95%) had good results by the Paavolainen method. There was one delayed union, malunion, and screw loosening. CONCLUSION: The patients treated with a locking compression plate had relatively good clinical and radiologic results, and a low complication rate. Moreover, the patients could exercise earlier due to good reduction and initial stability. Treatment of unstable proximal humerus fractures with a locking compression plate is a reliable method

The Diagnostic Utility of PET-CT for the Preoperative Evaluation of Lymph Node Metastasis in Gastric Cancer Patients

PURPOSE: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. MATERIALS AND METHODS: 119 patients (M:F=89:30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. RESULTS: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. CONCLUSION: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.

Delayed Splenic Rupture and Pancreatic Pseudocyst Following Extracorporeal Shock Wave Lithotripsy for a Urolithiasis

Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since 1980. Although it has proved to be a safe, effective treatment modality, it is not free of complications. As this procedure has become more widely available, complications as a result of injury to the kidney and the surrounding organs are being increasingly recognized. Those reported complications include hepatic hematoma, biliary obstruction, pancreatitis, colonic and splenic injury, bowel perforation, psoas abscess, aortic aneurysm rupture, portal and iliac vein thrombosis, retroperitoneal and brain hemorrhage, gastric erosions, pulmonary contusions and cardiac arrhythmias. Physicians caring for these patients should be mindful of these complications and keep an eye open to spot them. We report here on a case of a young male patient who developed splenic rupture and a pancreatic pseudocyst after undergoing extracorporeal shock wave lithotripsy (ESWL) for treating a left upper ureter stone.

Predictability of Magerl & McCormack's Load Sharing Classification on the Metal Failure after Pedicle Screw Fixation in the Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: A retrograde study of metal failures at thoracolumbar spinal fractures fixed using pedicle screws. OBJECTIVES: The predictability and usefulness of the McCormack's classifications for metal failures was compared with Magerl's classifications. SUMMARY OF LITERATURE REVIEW: The load sharing classification was introduced to predict metal failure after short-segmental pedicle screw fixation by McCormack. However, its reliability is uncertain. MATERIALS AND METHODS: From July 2000 to July 2003, this study examined the plain radiographs and CT images of 31 out of 46 patients who underwent posterior stabilization using pedicle screws for thoracolumbar fractures and could be followed up at least 1 year. Fractures were classified utilizing Denis's, Magerl's, and McCormack's systems. RESULTS: As a result of analysis of relation between metal failure and classification system by Magerl or McCormack, there was no significant difference in its distribution. There was no correlation between the fixation range and metal failures in type C3 fractures, but there was a correlation between short fixation and metal failures in rotational burst fractures in short fixation. CONCLUSIONS: In order to prevent metal failures after fixing thoracolumbar spinal fractures by pedicle screws, the stability should be evaluated using Magerl's classification and McCormack's total score. In addition, in cases of type C3 fractures according to the Magerl's classification, reconstructions should be carried out with a long segment fixation or anterior supporting bone grafts, particularly when McCormack's total score is greater than 7.

Indication of Interventional Treatment in Abdominal and Pelvic Trauma

PURPOSE: The aim of this study was to evaluate and establish the indications of interventional artery embolization in patients with a traumatic liver, spleen and pelvis injury. METHODS: 91 patients with a traumatic liver, spleen and pelvis injury, who had been treated with interventional arterial embolization from April 1992 to April 2004, were included in this retrospective study. The abdominal pelvic injuries were classified according to the CT scan findings based on the injury scale of the American Association for the Surgery of Trauma. The mechanism of trauma, initial vital signs, initial hemoglobin, hospital length, transfusion amount, shock index and fluid resuscitation amount were surveyed. All the patients underwent angiography. If there was evidence of an active hemorrhage during angiography, interventional arterial embolization with Gelfoam or stainless coil was performed. RESULTS: Among the 91 patients with a traumatic liver, spleen and pelvis injury, 25 out of 30 patients treated by hepatic arterial embolization, 36 out of 42 patients by splenic artery embolization and 14 out of 19 patients by pelvic artery embolization showed successful outcomes that were supported by shock index improvement (P<0.05), less fluid resuscitation requirements (P<0.05) and less packed red blood cell (RBC) requirements (P<0.05). CONCLUSION: Interventional artery embolization is a preferable non-surgical management for patient with a traumatic liver, spleen and pelvis injury. These results suggests that the indications of interventional arterial embolization are a shock index <1, transfusion amount to maintain a Hg level of 10 g/dl <3 pint per day and fluid resuscitation amount <2,000 ml per 2 hours.

Kinematical Characteristics of the Translational and Pendular Movements of each Cervical Vertebra at the Flexion and Extension Motion

PURPOSE: The aim of this study was to determine the kinematical characteristics of the pendular and the translational movements of each cervical vertebra at flexion and extension for understanding the mechanism of injury to the cervical spine. METHODS: Twenty volunteers, young men (24~37 years), with clinically and radiographically normal cervical spines were studied. We induced two directional passive movements and then took X-ray pictures. The range of pendular movement could be measured by measuring the variation of the distance between the center point of two contiguous cervical vertebrae, and the range of translational movement could be measured by measuring the variation of the shortest distance between the center point of a vertebra and an imaginary line connecting the center points of two lower contiguous cervical vertebrae. The measurements were done by using a picture archiving and communicating system (PACS). RESULTS: The total length of all cervical vertebrae in the neutral position was, on average, 133.66 mm, but in both flexion and extension, the lengths were widened to 134.83 mm and 134.79 mm, respectively. The directions of both the pendular and the translational movements changed at the 2nd cervical vertebra, and the ranges of both movements were significantly larger from the 5th cervical vertebra to the 7th cervical vertebra for flexion and combined flexion and extension motion (p<0.05). CONCLUSION: The kinematical characteristics for flexion and extension motions were variable at each level of cervical vertebrae. The 1st and the 2nd cervical vertebrae and from the 5th to the 7th cervical vertebrae were the main areas of cervical spinal injury. This shows, according to "Hook's law," that the tissues supporting this area could be weak, and that this area is sensitive to injury.

Kinematical Characteristics of the Translational and Pendular Movements of each Cervical Vertebra at the Flexion and Extension Motion

PURPOSE: The aim of this study was to determine the kinematical characteristics of the pendular and the translational movements of each cervical vertebra at flexion and extension for understanding the mechanism of injury to the cervical spine. METHODS: Twenty volunteers, young men (24~37 years), with clinically and radiographically normal cervical spines were studied. We induced two directional passive movements and then took X-ray pictures. The range of pendular movement could be measured by measuring the variation of the distance between the center point of two contiguous cervical vertebrae, and the range of translational movement could be measured by measuring the variation of the shortest distance between the center point of a vertebra and an imaginary line connecting the center points of two lower contiguous cervical vertebrae. The measurements were done by using a picture archiving and communicating system (PACS). RESULTS: The total length of all cervical vertebrae in the neutral position was, on average, 133.66 mm, but in both flexion and extension, the lengths were widened to 134.83 mm and 134.79 mm, respectively. The directions of both the pendular and the translational movements changed at the 2nd cervical vertebra, and the ranges of both movements were significantly larger from the 5th cervical vertebra to the 7th cervical vertebra for flexion and combined flexion and extension motion (p<0.05). CONCLUSION: The kinematical characteristics for flexion and extension motions were variable at each level of cervical vertebrae. The 1st and the 2nd cervical vertebrae and from the 5th to the 7th cervical vertebrae were the main areas of cervical spinal injury. This shows, according to "Hook's law," that the tissues supporting this area could be weak, and that this area is sensitive to injury.

Treatment of Tibial Condyle Fracture / 영남의대학술지

BACKGROUND: Clinical and radiological results based on fracture types and associated injuries after the treatment of tibial plateau fracture were evaluated for analyzing prognostic factors. MATERIALS AND METHODS: From June 1997 to June 2002, 50 cases were followed for at least 1 year. Mean age was 47.4 years, and mean follow period was 30.0 months. Fracture classification was performed by the Schatzker method. Clinical and radiological evaluation were performed by the Porter and Rasmussen method. Evaluation was based on degree of reduction and associated injuries, etc. RESULTS: The most common cause of injury was traffic accident (37 cases, 74%), The common fracture types by Schatzker classification were type II (14 cases) and VI (12 cases). Methods of treatment were screw fixation (15 cases), plate and screw (21 cases), external fixator (5 cases), and conservative treatment (9 cases). The most common associated injuries were ipsilateral fibular fracture (18 cases) and MCL (medial collateral ligament) injury (8 cases). CONCLUSION: Acceptable results after treatment of tibial plateau fracture were obtained from the anatomical reduction group, non-associated injury group, the young age group, and the early ROM (range of motion) beginning group.

Treatment of Tibial Condyle Fracture / 영남의대학술지

BACKGROUND: Clinical and radiological results based on fracture types and associated injuries after the treatment of tibial plateau fracture were evaluated for analyzing prognostic factors. MATERIALS AND METHODS: From June 1997 to June 2002, 50 cases were followed for at least 1 year. Mean age was 47.4 years, and mean follow period was 30.0 months. Fracture classification was performed by the Schatzker method. Clinical and radiological evaluation were performed by the Porter and Rasmussen method. Evaluation was based on degree of reduction and associated injuries, etc. RESULTS: The most common cause of injury was traffic accident (37 cases, 74%), The common fracture types by Schatzker classification were type II (14 cases) and VI (12 cases). Methods of treatment were screw fixation (15 cases), plate and screw (21 cases), external fixator (5 cases), and conservative treatment (9 cases). The most common associated injuries were ipsilateral fibular fracture (18 cases) and MCL (medial collateral ligament) injury (8 cases). CONCLUSION: Acceptable results after treatment of tibial plateau fracture were obtained from the anatomical reduction group, non-associated injury group, the young age group, and the early ROM (range of motion) beginning group.