Measuring the Impact of Femoral Head Size on Dislocation Rates Following Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate if the femoral head's size has an impact on dislocation rates following total hip arthroplasty (THA). MATERIALS AND METHODS: Five hundreds forty-three THA performed using a posterolateral approach in our hospital and followed up more than 6 months were included in this study. We evaluated dislocation rates based on the size of femoral head (28 mm vs. over 32 mm) and further investigated the dislocation rates classified into primary and revision surgery. Patient-related and surgical factors were reviewed to evaluate risk factors impacting dislocation rates. RESULTS: Dislocation occurred in 9.6% of cases (n=52; 32 males and 20 females). Of this dislocation group, 36 were treated with femoral heads 28 mm in diameter (9.8% of all patients treated with 28 mm femoral heads) and 16 were treated with femoral heads 32 mm and over (9.1% of all patients treated with femoral heads of at least 32 mm). The percentages of patients experiencing dislocation were not significantly different among the two groups (i.e., 28 mm vs. ≥32 mm). However, after revision surgery, the dislocation rate in the 28-mm group was significantly higher than the ≥32-mm group (P<0.05). In a case-control study comparing dislocation and non-dislocation groups, the risk of dislocation was 6 times higher in patients with habitual alcohol intake, and 9.2 times higher in patients with a neuropsychiatric disorder (P<0.05). CONCLUSION: Patient factors are considered to have a more significant impact on dislocation rates following THA than the size of femoral head.

Indirect Repair with Surgicel® and Fibrin Glue for Postoperative Cerebrospinal Fluid Leakage after Cervical Anterior Foraminotomy: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of indirect repair of cerebrospinal fluid (CSF) leakage after cervical anterior foraminotomy using Surgicel® and fibrin glue. SUMMARY OF LITERATURE REVIEW: There is no single modality that is best practice for this type of case because it is difficult to apply primary repair for a case of CSF leakage after cervical anterior decompression. MATERIALS AND METHODS: A 49-year-old female patient was diagnosed with CSF leakage on the second day after cervical anterior foraminotomy. We performed coverage with Surgicel® and fibrin glue at the CSF leak site. RESULTS: The patient was treated with indirect repair of CSF leakage without any complications. The clinical and radiological outcomes were excellent upon follow-up 1 year postoperatively. CONCLUSIONS: Indirect repair using Surgicel® and fibrin glue is an effective treatment for postoperative CSF leakage after cervical anterior foraminotomy.

Clinical characteristics of chronic fatigue and chronic fatigue syndrome in Korea

BACKGROUND: Chronic fatigue is a common symptom in primary care setting in Korea and classified into medically explained and unexplained according to the precipitating factors. The medically explained chronic fatigue may be associated with many well-known physical and psychological conditions and the medically unexplained chronic fatigue is classified into chronic fatigue syndrome and idiopathic chronic fatigue. The chranic fatigue syndrome is an illness that has unknown etiology and severe disabling fatigue and has been known to most physicians and public since mid-1980's. Many researches are ongoing in developed countries, although the pathophysiology and treatment of this syndrome are controversial. But in Korea, the researches for chronic fatigue and the chronic fatigue syndrome are very rare. Our goal was to assess the clinical characteristics of chronic fatigue and the chronic fatigue syndrome in Korea. METHODS: The study subjects were chronic fatigue patients visiting the chronic fatigue clinic in Kangbuk Samsung Hospital from Feb. 1. 1998 to Aug. 31. 1998 After medical history, physical examination, laboratary tests and questionnare(including fatigue, anxiety and depression scales), the study subjects were classified into the medically explained(psychological disorder and physical disorder group) and unexplained chronic fatigue patient groups(the chronic fatigue syndrome group and idiopathic chronic fatigue group). RESULTS: The final study subjects were 97 patients(psychologicsl disorder(20), physical disorder(20), idiopathic chronic fatigue(27), chronic fatigue syndrome(30)). Compared to the explained chranic fatigue group, uraxphined chronic fatigue group had higher female ratio, lower body mass index, lower blood pressure, higher fatigue scale scores, and the higher prevalence of anxiety and insomnia. CONCLUSIONS: From aur results, unexplained chronic fatigue patients had higher fatigue severity and higher prevalence of anxiety and insomnia than the explained chronic fatigue patients. Although there are limitations to generalizing the results of this study(selection bias), it is significant in that it is the first study of the chronic fatigue syndrome in Korea.