Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years: The Factors Influencing the Postoperative Mortality

PURPOSE: We wanted to evaluate the factors that influence the one-year mortality rate after bipolar hemiarthroplasty in elderly patients over 90 years of age and who had hip fractures. MATERIALS AND METHODS: In this retrospective study, we enrolled 42 cases (29 females and 12 males) that were treated by bipolar hemiarthroplasty for hip fractures between April 1999 and April 2008. The mean age was 94 (range: 90~101) years. We compared such variables as age, gender, BMD (bone mineral density), the ASA (American Society of Anesthesiologists) score, the type of fracture, the operation time, the type of anesthesia, the length of the ICU (intensive care unit) care, the length of hospitalization, operative delay and the postoperative ambulatory capability between the one-year mortality group and the control group (alive over a minimum of 1-year), and we investigated the risk factors related to one-year mortality. RESULTS: The one-year mortality rate was 32%. There were significant relationships between the postoperative one-year mortality and the ASA score, the length of the ICU care, operative delay and the postoperative ambulatory capability. The one-year mortality rate in the trochanteric fracture group was significantly higher than that in the neck fracture group. However, there were no relationships between the one-year mortality and age, gender, BMD, the length of operation, the type of anesthesia and the length of the hospitalization. CONCLUSION: The preoperative ASA score was significantly higher in the one-year mortality group among the elderly patients over 90 years of age and who were treated with bipolar hemiarthroplasty for hip fractures. The length of the ICU care, operative delay and the postoperative ambulatory capability were significantly associated with one-year mortality, and so all of these should be considered as postoperative prognostic factors.

The Trajectory of Iliac Screw in the Axial Plane in 200 Korean Patients

STUDY DESIGN: A retrospective radiographic analysis. PURPOSE: To estimate the accurate trajectory in the axial plane for iliac screw insertion in 200 Korean patients using radiographic images. OVERVIEW OF LITERATURE: Several complications have been encountered after fusion to the lumbosacral junction, including pseudarthrosis, S1 screw loosening, and sacral fractures. Iliac screw fixation is considered an efficient method for augmenting sacral screw fixation but there are few reports on the trajectory of iliac screw insertion. The trajectory in the sagittal plane can be visualized by intraoperative fluoroscopy. However, there is no method to check the accuracy of the trajectory in the axial plane during surgery. METHODS: Between January 2007 and February 2009, 200 patients (107 men and 93 women) who underwent L-spine computed tomography were enrolled in this study. The mean age of the patients was 55.6 +/- 18.3 years (range, 13 to 92 years). The spino-iliac angle (SIA) was measured on the axial image at the S1 level, which was defined as the angle between a vertical line through the center of the spinous process and an oblique line that passed through the center of the outer and inner cortices of the ilium. RESULTS: The group mean SIA was 30.1degrees +/- 7.8degrees; 30.1degrees +/- 7.7degrees for men and 29.9degrees +/- 81.1degrees for women. There was no significant difference according to gender or age (p > 0.05). CONCLUSIONS: The SIA for the axial trajectory of iliac screws is approximately 30degrees in Korean patients.

Colon Perforation during Air Enema Reduction of Intussusception

PURPOSE: Although air enema reduction has been known as a good method of diagnosis and treatment of intussusception, it could develop colon perforation. However, there have been few studies about this complication. So we analyzed the risk factors of colon perforation during air enema reduction in patients with intussusception. METHODS: We reviewed the charts of 12 colon perforation patients during air enema reduction of intussusception, who were admitted to Gil Medical Center from Jan. 1990 to Dec. 2001. Their age, sex, major symptoms, length of time till hospital visit, types of intussusception, operative findings and pathologic reports were reviewed. RESULTS: Among 657 cases, 596 patients(90.7%) were successfully treated, but 12 patients(1.83%) failed in air enema reduction and had colon perforation. In patients with colon perforation the male to female ratio was 11 : 1, and average age was 5.3 months. The most common symptom at the time of hospital visit was vomiting(91.7%). Cyclic irritability(75.0%), bloody stool(75.0%) and abdominal mass(41.7%) were also noted. The average length of time between symptom onset and hospital visit was 44.7 hours. Types of intussusception were predominantly ileocolic, ileocecal, and ileoileocolic. The site of perforation was most commonly found at the proximal part of intussusception including ascending colon(50%) and transverse colon(50%). Most cases were uncomplicated, and had a single perforation. Pathologic reports showed hemorrhagic necrosis and mesenteric laceration at the site of colon perforation. Complications of colon perforation were tension pneumoperitonium(58.3%), requiring immediate decompression. CONCLUSION: The chance of colon perforation during air enema reduction increases in cases with small bowel obstruction on simple abdominal x-ray of a patient younger than 6 months, delay in time till hospital visit and higher air pressure during reduction. Therefore more careful investigation is needed in these cases.

Case Report on the Application of Tele -education Developed for the Anatomy Education / 체질인류학회지

The authors have made an anatomy CD titled Human Anatomy (Ministry of Culture & Tourism registration number 980052) for the self study by students and have used it in anatomy classes. For better student -centered and individual education, the introduction of remote education or interactive tutorial site was inevitable. In this study, amelioration report will be presented on the development and trials of this interactive tutorial site. Total hits for attending classes were 337.5 times, making 4.1 hits per student. About 76 messages were posted on the Q&A board, less than one per student. One assignment was given per lecture and all 82 students have submitted their report. Without delay after test, all students were able to check their grades and ranks between other students. Professors were able to evaluate the percentage of correct answers per question and the average of the score. An online discussion was held for 30 minutes after each lecture. On average, 37 students were participated in the discussion. After the term, evaluation survey in the remote education or interactive tutorial on the internet was made. Eighteen students (26%) have chosen 'good', 'bad' 13 students (19%), 'not much different' 38 students (55%). One the other side, 8 (12%)-'good', 19 (28%)-'not much different', 32 (46%)-'bad' figures were shown for remote examination. From this result, it is guessed that students who are not used to using computers have shown negative feeling from the burden that they had to use a computer to take exams, not demonstrating their full ability. To see all the results of this study, you can log in at http://anatomy. hallym.ac.kr as guest ID '000' and password '000'.

Two Cases of Rotor Syndrome in Siblings / 대한소아소화기영양학회지

We experienced two cases of Rotor syndrome in brothers who were a 13 year-old boy and an 11 year-old boy, respectively. They presented with icteric scleras for a few months. Their common laboratory characteristics were as follows: Direct bilirubin was more increased than indirect bilirubin, but aminotransferases were normal. Plasma indocyanine green (ICG) test revealed hepatic excretory defect: plasma ICG concentrations 15 minutes after intravenous injection were 80.45% and 78.28%, respectively. 99mTc-DISIDA Hepatobiliary scan showed that severely decreased hepatic extraction with mild cardiac blood pool, markedly delayed biliary excretion in both intra- & extra- hepatic bile ducts, delayed visualization of gall bladder, and markedly delayed intestinal biliary passage. Needle liver biopsy showed normal hepatic histology without pigmentation.

Regional Distribution of Zinc Transporter 3 (ZnT-3)-Immunoreactivities in the Mouse Cerebellum / 대한해부학회지

The presence of the zinc ion pump antibody ZnT-3 in zinc enriched (ZEN) cerebellar axonal terminals was detected in immunohistochemical sections of mouse cerebellum. All the ZnT-3-immunoreactive structures appeared punctate in the cerebellar cortex, while the white matter including intrinsic nuclei were void. The staining intensity varied in the different phylogenetic divisions of cerebellum. Archicortex was stained most intensively while paleo and in particular neocortex was stained only faintly. The ZnT-3 fraction was detected mainly in the upper half of the granule cell layer (GCL), although where they appeared ultrastructurally in small folded varicosities located corresponding to axon terminals of the Golgi cells. In the molecular layer (ML), the ZnT-3 staining was found to be distributed diffusely but in perpendicular radiating pattern through the layer but with the most intense staining in the upper half of the layer. Ultrastructurally the coarse patches of staining found in the granule cell layers were corresponded to presynaptic axon terminals contacting with granule cells. No ZnT-3 staining was observed in the Purkinje cell layer. The present results suggest that the Golgi cells in the mouse cerebellum are one of the ZEN neurons in the mammalian brain. In conclusion, we first showed putative ZEN terminals in the mouse cerebellum. These results will provide a valuable aid for investigation of further localization of the ZEN neurons in the mammalian cerebellum. More work is needed to further characterize the ZEN terminals, and so autometallographical studies are currently being investigated in this laboratory.

Protection Effects of the Adrenalectomy on the Neuronal Death following Kainc Acid in the Rat Hippocampus / 대한해부학회지

Chelatable zinc ions from synaptic vesicles have been shown to contribute to neuronal death caused by stroke, epilepsy and head trauma. Elevated glucocorticoid concentration exacerbates such neuron loss, while low levels protect. We have tested the notion that the neuroprotective effect of prior glucocorticoid reduction is mediated by a reduction of zinc ions, i.e. a decrease in the level of zinc ions contained in zinc-enriched (ZEN) synaptic vesicles. The level of vesicular zinc ions was evaluated by zinc selenium AMG (ZnSeAMG) staining at 10 and 30 days after adrenalectomy (ADX). The staining intensity was significantly decreased in the hippocampus following the ADX. Adrenalectomized rats showed proconvulsive seizure behavior, i.e. shortened latency to seizure onset time and increased seizure score 3 hrs after i.p injection of kainic acid (KA). However, adrenalectomized rats showed decreased hippocampal CA3 neuronal death 24 hrs following the KA injection. The convulsive seizure in the ADX rats results from the decreased contents of the vesicular zinc in the presynaptic neurons of the hippocampus. The decreased zinc translocation following the KA injection contributes to the increased neuronal survival rates of postsynaptic neurons against the zinc toxicity in the ADX rats. The present data suggest that the glucocorticoid influences vesicular zinc concentration in the CNS.

Comparison of Intraventricular Hemorrhagic Findings in Preterm Infants Between Brain Ultrasonogram and Magnetic Resonance Imaging at Discharge

PURPOSE: It has been customary to perform brain ultrasonogram (brain US) for the early detection of intraventricular hemorrhage (IVH) during intensive care of neonates. On the other hand magnetic resonance imaging (MRI) has been greatly restrictioned due to its complicated procedures. This study was conducted to identify changes in neonates' brain structure and to gain basic data for the long-term follow-up of neurologic sequelae in the future. For this purpose, the findings obtained from both brain US performed within one postnatal week and MRI at the time of discharge were compared and analysed. METHODS: Brain US within one postnatal week and MRI at discharge were carried out on 67 neonates who were discharged from the neonatal intensive care unit of Fatima Hospital from July 01, 1996 to June 30, 1998. We compared and analysed IVH found in the brain US, and focal parenchymal hemorrhage, periventricular leukomalacia (PVL), basal ganglia hemorrhage, and encephalomalacia revealed the MRI performed at discharge. RESULTS: It was found that out of 67 cases from the brain US, there were 13 with IVH of Grade l & ll, 11 with IVH of Grade lll or higher, one with focal parenchymal hemorrhage, and three with PVL. Also the MRI found seven with focal parenchymal hemorrhage, one with basal ganglia hemorrhage, six with PVL, three with encephalomalacia, and one with ventricular dilatation. CONCLUSION: For infants with IVH of Grade lll or higher, MRI performed at discharge is considered to be very useful in identifying structural parenchymal abnormality and the presence or absence of its associated lesions as well as in carrying out long-term follow-up.

Clinical Study of Status Epilepticus in Children

PURPOSE: Convulsive status epilepticus(SE) is a serious, life-threatening neurological condition that requires immediate treatment to avoid significant morbidity and mortality. Despite improvements in the diagnosis and treatment of SE in the last two decades, SE in young infancy is still associated with high morbidity and mortality. Thus, understanding the varied etiology and clinical presentation and prognosis of SE is very important for improving the methods of evaluation and treatment of this major neurological condition. METHODS: Eighty-eight cases with 53 who have been admitted to the Department of Pediatrics, Fatima Hospital during the period of July, 1992 to June, 1997 were included. We described age distribution, etiologic classification according to age, seizure type, neurologic outcome, recurrence of SE and epileptic seizure. RESULTS: SE was frequent in young infant less than 3 years of age. Major etiology of SE was acute symptomatic(34.1%) and febrile(31.8%). In the seizure type, the majority(92.1%) was generalized convulsive, many cases(69.3%) of SE were first seizures. The neurologic sequelae were found in 15.9% and mortality rate in 5.7%. The neurologic sequelae and mortality were higher in acute symptomatic. In sixty-three follow-up cases, eleven cases were epileptic seizure, eight cases were recurred SE and two cases were recurred febrile SE. CONCLUSION: SE is a life-threatening neurological condition and occurrs mostly in young infants less than 3 years of age. It requires immediate detection of etiology in SE and aggressive treatment for reducing mortality and morbidity rates.