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.

Primary Leptomeningeal Malignant Melanoma

Primary leptomeningeal malignant melanoma is rare entity. We present a case of primary leptomeningeal malignant melanoma of 66-year-old male, who had suffered severe headache, confusion, and right hemiparesis. The brain computed tomography and magnetic resonance image revealed a well enhancing mass with hemorrhage in the left fronto-parietal region. Total surgical removal of the lesion was performed without neurological deficit. He died at home 6 months after operation. Probably, it seems that the cause of death was poor general condition due to obtunded mentality or brain herniation due to increased intracranial pressure. The literature on this subject is briefly reviewed.

The Advantages of Rectangular Titanium Cage(RABEA) Fusion after Anterior Cervical Discectomy: Comparative Study of Fibula Allograft

OBJECTIVE: To study the safety and efficacy of using rectangular titanium cage(RABEA) for anterior cervical fusion, we have compared the results of fusion performed by using fibula allograft and RABEA cage. METHODS: Total of 74 patients with single level cervical discectomy were included in this study. Allogenic fibula bone graft alone was done in 38 patients and RABEA cage was inserted in 36 patients. Retrospective clinical analysis was based on review the symptoms and radiological findings on both two groups at postoperative 12 months. RESULTS: Solid fusion was achieved in 95% of patients who received rectangular titanium cage and 74% of patients who received fibula allograft. According to Odom's criteria, 92% of patients were found to have excellent or good results in the RABEA cage group and 68% of patients in allograft group. Functional outcome was assessed according to Odom's criteria and patient's postoperative satisfaction index(PSI). Better clinical outcome and solid fusion could be achieved by rectangular titanium cage fusion than allogenic fibula graft after single level anterior cervical discectomy. CONCLUSION: We believe that RABEA cage is an effective and safe cervical fusion substitute for single level cervical fusion after discectomy.

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.

Localized Pigmented Villonodular Synovitis with Recurrent Subluxation of the Patella: A Case Report / 대한정형외과학회잡지

Pigmented villonodular synovitis is a slow, usually monoarticular, progressive proliferative disorder of uncertain etiology involving joint tissue, tendon sheath, and bursae. Pigmented villonodular synovitis has been divided in two forms-diffuse and localized. Localized pigmented villonodular synovitis of the knee joint can present with symptoms of pain, locking and instability. We report a case of a patient who presented with symptoms of recurrent subluxation of patella due to a localized pigmented villonodular synovitis occurring in the medial patellofemoral joint.

Anterior Interbody Fusion using a Horizontal Cylinder Cage in a Degenerative Lumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the surgical effect of anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine. MATERIALS AND METHODS: We evaluated 16 patients (at 20 levels) who received anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine or in secondary segmental lumbar instability following decompression at the same level from May 1997 to May 1998. Preoperative, postoperative, and follow-up radiographs were taken to compare the posterior disc height, neuroforaminal area, and the neuroforaminal volume. Fusion rates and clinical results were also reviewed. RESULTS: Posterior disc height (mm), neuroforaminal area (mm2) and neuroforaminal volume (mm3) were increased and maintained during the follow-up period. Radiological fusion was noted in 17 levels (85%) at a postoperative 1 year. Satisfactory clinical results were also obtained in 17 levels (85%). CONCLUSION: Anterior interbody fusion using a horizontal cylinder cage might be an effective method in the surgical treatment of degenerative lumbar spine or secondary segmental lumbar instability.

Reconstruction of ankle using free vascularized flap from amputated hand: A case report / 대한정형외과학회잡지

It is indispensable to cover the skin defect when bone or tendon is exposed. In case of inevitable amputation of an extremity, it is possible to harvest a free flap from the amputed limb for providing coverage of the other wound. This technique allows immediate wound coverage without the morbidity of an additional donor site. We experienced an electrical burn case with inevitahle wrist disarticulation and successfully treated soft tissue defect of ankle using free vascularized flap.

Effects of Burn Injury on the Physis of the Proximal Tibia in the Growing Rat / 대한정형외과학회잡지

This study was designed to investigate the effects of burn injury of the leg on the growth plate of proximal tibia in the immature rat. The procedure for burn injury of left leg was performed at the thigh, knee and lower leg under the general anesthesia with inhalation of ether. After the burn injury, follow up observations were made at second day, 1st, 4th, and 6th weeks with histological examination. The results were as follows. During postburn 4 weeks, height of the proximal tibial epiphyseal plates of the experimental group showed significant increment, comparing with control group. At postburn 6th weeks, it revealed no significant difference, comparing with control group (Wilcoxon rank sum test, p<0.05). During postburn 4 weeks, cell numbers in column of the proximal tibial epiphyseal plates of the experimental group showed significant increment, c omparing with control group. At postburn 6th weeks, it revealed no significant difference comparing with control group (Wilcoxon rank sum test, p<0.05).

Very Long Island Pedicled Sole - fillet Flap for Below - Knee Amputation Stump Reconstruction: 2 Cases Report / 대한정형외과학회잡지

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wound. In cases of inevitable extremity amputation, the transfer of pedicled flap from the amputed part is possible. In such substance, it is possible to obtain the pedicled fillet flap from the amputed limb to provide stump coverage. We experienced two cases of below-knee amputation due to severe flame burn which the stump was covered with island pedicled sole-fillet flap.

Cementless Total Hip Arthroplasty for Avascular Necrosis of the Femoral Head: The influence of the extent of involvement in outcome / 대한정형외과학회잡지

The purpose of this study is to evaluate the influence of the extent of involvement in the results of cementless THA in patients with idiopathic AVN of the femoral head. We reviewed 70 hips (52 patients) who had undergone cementless THA for idiopathic AVN of the femoral head. Anatomic femoral components were used in 43 hips and Harris Galante porous prosthesis were employed in 27 cases. The hips were classified according to International Classification (Association Research Circulation Osseous). The length of the follow-up period ranged from 3 to 5 years (average 53.5 months). Preoperative and postoperative clinical documentation and radiographs were evaluated. Statistical analysis was performed on the results of three analysis groups (Group A, comparison of results among Stage IIIA, IIIB, IIIC, and IV; Group B, between stage III and IV; Group C, between IIIA+IIIB and IIIC + IV). Of the 70 hips in the present study, there were 47 hips in stage III (IIIA, 15; IIIB, 19; IIIC, 13) and 23 hips in stage IV. The average postoperative Harris hip score at the time of study was 91.5 (Analysis Group C, p=.009). Femoral subsidence of more than 5 mm occurred in 5 hips (7.1%). Two hips were in Stage IIIC and three hips were in Stage IV (Group C, p=.024). The hips lower than -10 on Engh's index were present in one hip in Stage IIIC and three hips in Stage IV (Group C, p=.011). This study demonstrated that the clinical and radiological results of cementless THA were poor when the extent of involvement was greater or in the case of late stage subjects, particularly those above IIIC (p<05), with avascular necrosis of the femoral head.

Bilateral Naviculo-Medial Cuneiform Coalition: One Case Report / 대한정형외과학회잡지

We report one case of bilateral naviculo-medial cuneiform coalition in ten year old girl. She complained of pain in the medial aspect of the mid-foot related to long periods of standing and activity. Routine roentgenographs, specifically lateral views showed a bony bridge between the navicular bone and medial cuneiform. A biopsy revealed as fibrocartilaginous tissue. The bony bridge consists about one third in lateral view and 30 degree cephalad tilting in the antero-posterior view. Bilateral resection arthroplasty, with interposing flesh muscle fibers of the abductor hallucis, was performed for restoration of motion in the naviculo-medial cuneiform joint and relief of localized pain. Four months after surgery, pain around the mid-foot had almost complete subsided. One year postoperative, neither recurrence nor disability was observed. We will discuss the diagnosis and treatment of this rare case of bilateral naviculo-medial cuneiform coalition.