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No abstract available.
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BACKGROUND: The purpose of this study was to determine whether there is a learning curve for internal fixation for nondisplaced femoral neck fractures using the cumulative sum (CUSUM) technique. We applied the CUSUM technique in monitoring performance of a single surgeon in internal fixation for nondisplaced femoral neck fractures. METHODS: Fifty consecutive patients who underwent internal fixation for nondisplaced femoral neck fractures were evaluated retrospectively. Loss of fixation within 6 months postoperatively was considered as failure of treatment. Patients were stratified into the early experience group (cases 1 to 25) and the late experience group (cases 26 to 50). The CUSUM method was used to analyze the learning curve. RESULTS: There was no failure of treatment during study period. The operation time became shorter with experience. Using the CUSUM analysis to plot the learning curve, there was no significant learning curve observed for multiple pinning for nondisplaced femoral neck fractures. CONCLUSIONS: The CUSUM analysis revealed there was no obvious learning curve to become proficient at internal fixation for nondisplaced femoral neck fractures, if technical principles were followed during the procedure.
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Humanos , Fraturas do Colo Femoral , Colo do Fêmur , Fixação de Fratura , Curva de Aprendizado , Aprendizagem , Métodos , Estudos RetrospectivosRESUMO
BACKGROUND: The incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures. METHODS: We have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study. RESULTS: Three eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001–2004, 2005–2008, and 2006–2010, respectively). CONCLUSIONS: The age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.
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Feminino , Humanos , Masculino , Fraturas do Quadril , Quadril , Incidência , Coreia (Geográfico)RESUMO
STUDY DESIGN: Retrospective fusion level(s)-, age-, and gender-matched analysis. PURPOSE: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. OVERVIEW OF LITERATURE: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. METHODS: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. RESULTS: The total drain amount for the first 24 hours (8+/-9 versus 27+/-22 mL), total drain amount until the 8-hour drainage decreased to < or =10 mL (8+/-10 versus 33+/-26 mL), and the total drain amount until 6 AM on the first postoperative day (7+/-8 versus 24+/-20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to < or =10 mL was significantly lower in the study group (10+/-5 versus 26+/-14 hours, p<0.001). The 8-hour drainage decreased to < or =10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. CONCLUSIONS: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.
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Feminino , Humanos , Vértebras Cervicais , Discotomia , Drenagem , Hematoma , Hemostasia , Hemorragia Pós-Operatória , Estudos Retrospectivos , Fusão VertebralRESUMO
Actinomycosis is a chronic supprative infectious disease usually caused by Actinomyces israelii. It is the anaerobic bacterium, rare in pelvic actinomycosis and usually found in patient who had inserted the intrauterine contraceptive devices. Prolonged high-dose therapy with penicillins is necessary for the treatment of this disease. A case of a 44-year-old woman, who presented with low abdominal pain is reported. She had a 10 years history of intrauterine device insertion and was diagnosed with computed tomography. Actinomycosis is not well treated by drug and surgically removed in many cases. We report a case of experience that treated by drug.
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Adulto , Feminino , Humanos , Dor Abdominal , Actinomyces , Actinomicose , Doenças Transmissíveis , Dispositivos Intrauterinos , PenicilinasRESUMO
Fibroepithelial polyps are a benign neoplasm of mesodermal origin that usually occur in the urinary tract. However, a giant fibroepithelial polyp of the glans penis is very rare and is strongly linked with long-term condom catheter use. In this article, we report a case of a 45-year-old man who presented with a giant fibroepithelial polyp originating from the glans penis. Physical examination showed a 6x3 cm sized mass lesion overlying the ventral surface of the glans near the urethral meatus without urethral communication. For the previous 10 years, the patient had been required to use a condom catheter secondary to paraplegia sustained during a T12-L1 spinal cord injury. He was successfully treated by wide local excision of the mass and suprapubic cystostomy placement. There was no evidence of recurrence after 12 months of follow-up.
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Humanos , Masculino , Pessoa de Meia-Idade , Catéteres , Preservativos , Cistostomia , Seguimentos , Mesoderma , Neoplasias Fibroepiteliais , Paraplegia , Pênis , Exame Físico , Pólipos , Recidiva , Traumatismos da Medula Espinal , Sistema UrinárioRESUMO
PURPOSE: An altered mental state is a common chief complain at the emergency departments (EDs). But it is difficult to find out the reason for this mental change. Serum biomarkers are an alternative way to diagnose the reason for mental change. We determined the values of four biomarker for diagnosing the mental changes of the patients seen at the ED: BNP, d-dimer, MMP-9 and S100beta. METHODS: From September 2007 to March 2008, we prospectively enrolled 42 adult patients who visited the ED of Hospital because of an altered mental status. We categorized the patient's mental state into 5 steps (alert to coma), and we took samples of blood at the time of visiting the ED. We then measured the 4 serum markers. The clinical records were reviewed to analyze the usefulness of these 4 serum markers. RESULTS: We enrolled 42 patients (24 females and 18 males). Thirty-three people were diagnosed with stroke and 7 people were diagnosed to not have stroke. The measurements of BNP, d-dimer and MMP-9 were on average 136.5+/-231.7 pg/mL, 2052.2+/-2071.8 ng/mL and 294.9+/-311.7 ng/mL, respectively, and S100beta was mostly measured below 100 pg/mL. After statistic analysis, only MMP-9 had diagnostic value for stroke, and BNP & d-dimer had a negative relation to making the diagnosis of stroke. CONCLUSION: MMP-9 is useful for making the different diagnosis of acute stroke in patients with an altered mental status at the ER. There is the probability of metabolic causes for ED patients' depressed mentality when the BNP and ddimer levels are highly elevated, but further study is needed to confirm this.
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Adulto , Feminino , Humanos , Biomarcadores , Transtornos da Consciência , Emergências , Produtos de Degradação da Fibrina e do Fibrinogênio , Estudos Prospectivos , Acidente Vascular CerebralRESUMO
PURPOSE: The purpose of this study was to investigate the usefulness of heart-type fatty acid binding protein (H-FABP) and ischemia modified albumin (IMA) to differentiate the causes of cardiac arrest. METHODS: From May 2007 to November 2007, we prospectively studied 27 patients who presented to the emergency department with sudden collapse. The blood samples collected during cardiopulmonary resuscitation (CPR) were centrifuged at 3000 rpm for 10 min, and the obtained serum was stored at -70degrees C. RESULTS: Cardiac arrest were caused by cardiac disease (N=7, 26%), trauma (N=7, 26%) and other disease (N=13, 48%). The patients with cardiac cause showed significantly increased H-FABP levels compared to the patients with noncardiac causes (39.7+/-19.3 ng/mL vs 24.6+/-16.9 ng/mL, respectively, p=0.048). The cut-off value of H-FABP was 29.05 ng/mL (sensitivity 85%, specificity 75%). The IMA showed no statistical difference between the patients with cardiac causes and those with non-cardiac causes (86.6+/-29.9 U/mL vs 107.4+/-39.4 U/mL, respectively, p=0.219). There were no significant differences of the H-FABP and IMA levels between the return of spontaneous circulation (ROSC) group and the non-ROSC group, and also between the survival and death groups. A higher H-FABP concentration was correlated with a longer arrest time, and mortality was correlated with a longer CPR time. CONCLUSION: The IMA is not changed according the cause of arrest, but the H-FABP is useful to diagnose the cardiac causes of arrest.
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Humanos , Biomarcadores , Reanimação Cardiopulmonar , Proteínas de Transporte , Emergências , Parada Cardíaca , Cardiopatias , Isquemia , Estudos Prospectivos , Sensibilidade e Especificidade , Albumina SéricaRESUMO
PURPOSE: Alfuzosin XL (Sanofi-Aventis, UroXatral(R)) has to be taken just after a meal for the best efficacy due to its specific pharmacokinetics. We studied patient compliance and associated factors with regard to the correct instructions for taking alfuzosin XL. MATERIALS AND METHODS: Alfuzosin XL was prescribed to 62 patients from February to May 2008. At the first visit, we provided a prescription for alfuzosin XL with the instructions to "take one tablet just after dinner once a day". At the second visit, we evaluated patient compliance and the factors that influenced the patient compliance for taking the alfuzosin XL. The physician explained the instructions to the patients. At the third visit, we compared the compliance and associated factors with the results from the first visit. RESULTS: A total of 50 patients completed the study. After the first visit, twenty one patients (42.0%) were not taking the alfuzosin XL according to the prescription, that is, 20 patients took alfuzosin XL before going to bed, and one patient before meals. (p<0.05) After direct instructions by a physician, 49 patients (98.0%) took the alfuzosin XL correctly. (p<0.001) CONCLUSIONS: Taking alfuzosin XL as prescribed was accomplished in only 58% of patients. When alfuzosin XL is prescribed, the physicians should be aware of the importance of providing instructions directly to patients.
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Humanos , Complacência (Medida de Distensibilidade) , Refeições , Cooperação do Paciente , Prescrições , QuinazolinasRESUMO
PURPOSE: To reveal the pattern of change of the prostate-specific antigen (PSA) level in asymptomatic men younger than 45 years whose PSA level was >or=4.00ng/ml. MATERIALS AND METHODS: Between January 2003 to October 2007, 105 men (or=45-year-old) were respectively referred from a health promotion center due to an elevated PSA level(>or=4.00 ng/ml). Among them, the men with prostatitis-associated symptoms and pyuria(>or=5WBC/HPF) on urinalysis, those taking medication that influence the PSA level or those men with a short follow-up period(or=45 years(group 2). RESULTS: The data from 38(group 1) and 87(group 2) men was finally analyzed respectively. In group 1, the median age was 41(25-44) and the initial PSA level was 5.60ng/ml (4.10-17.00). The PSA levels in 31 men (81.6%) decreased spontaneously during a median follow-up period of 20 months, and the PSA levels in 18 men(47.4%) were spontaneously normalized(<4.00ng/ml), and both of which were significantly higher as compared with those values in group 2(48.3% and 28.7% respectively). Prostate biopsies were performed in 3 men(group 1), and 33 men(group 2); all of these revealed benign disease. CONCLUSIONS: Despite of an abnormal elevation of PSA, if men are younger than 45 years and they have no specific urologic symptoms, there is little need for immediate exploration for prostatitis or to prescribe antibiotics because the PSA levels decline spontaneously in many cases.
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Humanos , Masculino , Antibacterianos , Biópsia , Seguimentos , Promoção da Saúde , Próstata , Antígeno Prostático Específico , Neoplasias da Próstata , Prostatite , UrináliseRESUMO
OBJECTIVE: Insufficiency fracture (IF) occurs when normal or physiological muscular activity stresses a bone that is deficient in mineral or elastic resistance. We studied clinical characteristics of IF in patients with chronic inflammatory joint diseases in Korea. METHODS: Between Aug. 1997 and Feb. 2003, thirty five patients with 77 fractures were studied at the authors' institution when they were being treated for their rheumatic diseases. The clinical and laboratory data were collected by review of medical record retrospectively. RESULTS: All patients except four were postmenopausal women (mean age 63.0+/-10.0 years) with long disease duration (mean 14.2+/-11.6 years). Thirty three patients had rheumatoid arthritis, 1 ankylosing spondylitis and 1 systemic lupus erythematosus. Twenty nine patients (85.7%) were receiving regular steroid treatment (mean dose 4.0+/-2.3 mg/day, mean duration 6.1+/-4.2 years). Twenty four patients were treated with methotrexate. The significant reduction in their bone mineral density was found 27 patients based on BMD or QCT. Eight patients without osteoporosis were treated with steroid or MTX. Twenty three patients were ever used for osteoporosis treatment. Most patients except four presented with pain in the low back, groin, hip, pelvic, leg and knee. Initial simple radiography was positive in only 7 patients, with vertebral compression fracture in 11 patients and no effect on mobility except ten. Diagnosis was delayed (mean duration of symptom until diagnosis was 45.6+/-64.5 days). IF was confirmed using the bone scan. Sacrum and pelvic bone was most frequently affected site. The other sites were SI joint, iliac wing, symphysis pubis, acetabulum and femur neck. Twenty nine patients required in-patient stay (mean 17.4 days). All but one patient showed an uneventful recovery with conservative treatment. CONCLUSION: The low grade nature of symptoms, minimal effect on mobility, absence of significant trauma and missed on initial plain radiography make diagnosis difficult and delayed. IF should be suspected in cases of unexplained pain with local tenderness in patients of chronic inflammatory joint diseases. The technetium-99m diphosphonate bone scintigraphy was valuable diagnostic tool in the early recognition of IF.
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Feminino , Humanos , Acetábulo , Artrite Reumatoide , Densidade Óssea , Diagnóstico , Colo do Fêmur , Fraturas por Compressão , Fraturas de Estresse , Virilha , Quadril , Artropatias , Articulações , Joelho , Coreia (Geográfico) , Perna (Membro) , Lúpus Eritematoso Sistêmico , Prontuários Médicos , Metotrexato , Osteoporose , Ossos Pélvicos , Radiografia , Cintilografia , Estudos Retrospectivos , Doenças Reumáticas , Sacro , Espondilite AnquilosanteRESUMO
There are many methods in reconstruction for skin defect in hand and forearm. Among them, reverse ulnar artery forearm flap has several advantages which are versatile, safe and convenient flap. We report 6 cases of our experiences.
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Traumatismos do Antebraço , Antebraço , Mãos , Pele , Artéria UlnarRESUMO
We present a case of medial malleolus and deltoid ligament loss with extensive overlying soft tissue defect from crushing injury. The resultant gross medial ankle instability necessitated deltoid ligament reconstruction using a bone-patellar tendon graft.
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Criança , Humanos , Tornozelo , Ligamentos , Patela , Ligamento Patelar , Tendões , TransplantesRESUMO
The percutaneous pinning is a simple, effective method for the treatment of displaced supracondylar fractures of the humerus in children. But there is some controversy in the number of pins used and the method of pin insertion. The cross pinning method provides more stability at the fracture site but the risk of ulnar nerve damage is higher than in lateral pinning method, The senenty-one displaced extension type supracondylar fractures were treated by closed reduction and percutaneous cross pinning from January 1991 to October 1994. Among them, the medial pin was inserted in elbow extension in twenty-eight cases and in forty- three cases the medial pin was inserted in elbow flexion. Ulnar nerve injury occured postoperatively in six cases, in which the pin was inserted with the elbow in flexion position. These results may suggest that when percutaneous cross pinning method is selected to fix the supracondylar fracture of the humerus, it would be safer to insert one or two lateral pins with the elbow in full flexion position followed by one medial pin in extension position in order to reduce the risk of loss of reduction and ulnar nerve damage.