• Tuberculosis and Respiratory Diseases
• /
• v.72 no.2
• /
• pp.191-196
• /
• 2012

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.

• Clinics in Shoulder and Elbow
• /
• v.20 no.4
• /
• pp.201-207
• /
• 2017

Background: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a $70^{\circ}$ arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. Methods: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a $30^{\circ}$ arthroscope in the conventional group, but two portals and a $70^{\circ}$ arthroscope as well as the $30^{\circ}$ one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. Results: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the $70^{\circ}$ arthroscope. Conclusions: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a $70^{\circ}$ arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

• Archives of Plastic Surgery
• /
• v.41 no.6
• /
• pp.709-715
• /
• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• Journal of Trauma and Injury
• /
• v.33 no.1
• /
• pp.38-42
• /
• 2020

Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

• Journal of Chest Surgery
• /
• v.8 no.2
• /
• pp.101-108
• /
• 1975

Since 1959 the authors experienced 43 cases of chronic constrictive pericarditis treated surgically at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seonl. Of 43 cases, detailed patients' records could be obtainable in 36 cases, and most of our studies. were made on the basis of these 36 available cases. About 84 per cent of the cases were male with several pediatric cases, and duration of symptoms ranged between 2 months and 10 years. The diagnosis of this condition is not difficult, however, about half of our cases were previously treated under the impression rf various other conditions such as liver cirrhosis or nephrotic syndrome at other hospitals and clinics. Many of our cases showed hepatic functional disturbances and about 89 per cent of the cases showed reversed A/G ratio, and we are sure that some of them had so-called protein losing enteropathy. Three of 36 cases showed normal electrocardiogram, and most peculiar electrocardiographic findings were ST or T changes and low amplitude of QRS complexes. Seven cases showed auricular fibrillation and five had first degree A-V block. Mean preoperative peripheral venous pressure at the antecubital fossa and arm-to-tongue circulation time were 273 mm $H_2O$and 20.2 seconds, respectively, and they were markedly reduced postoperatively to 152 mm $H_2O$ and 13 seconds, respectively. Several different approaches were made with various extents of pericardial decortication according to patients' condition and probably surgeon's preference. In 12 cases we met cardiovascular injuries during decortication and one of them died of massive bleeding through the torn right atrium, and we experienced excellent postoperative result in a grave case operated on just a small pericardial window. Eleven of 35 cases were tuberculous pericarditis and others were non-specific pericarditis histopathologically, and 6 of total 43 cases operated on passed away by various ways with the mortality rate of 13.9 per cent.

• Journal of Korean Foot and Ankle Society
• /
• v.13 no.2
• /
• pp.156-161
• /
• 2009

Purpose: The fracture of talus has critical complications and results in various clinical outcomes. The purpose of this study is to evaluate clinical outcome and influence on involvement of ankle and subtalar joint. Materials and Methods: From December 1999 to December 2008, a total of 66 fractures and dislocations of talus was treated with minimal 9 months follow up period. Ankle-hindfoot scale of the American Orthopedic Foot & Ankle Society (AOFAS) was used to evaluate the clinical outcome. The complications and sequential radiologic findings were also analyzed. Results: There were 28 neck fractures, 11 lateral process fractures, 10 body fractures, 7 osteochondral fractures, 4 posteromedial tubercle fractures and 4 medial process fractures. In 38 cases, there were concomitant injuries. Ipsilateral ankle fracture, which found in 19 cases, was most common. The surgical treatment was performed in 36 cases. Mean AOFAS score was 85.5 (range, 72 to 96). In 13 of 47 cases, one or more fracture lines involving weight bearing surface were confirmed. The involvement of ankle or subtalar joint had resulted in unsatisfied outcome. Complications were developed as follows, post-traumatic arthritis in 8 cases, avascular necrosis in 3 cases, and deep infection in 2 cases. Conclusion: The involvement of ankle or subtalar joint in fractures of talus seemed to be common and to impact the clinical outcome. Meticulous consideration about that will be positively necessary.

• Archives of Plastic Surgery
• /
• v.39 no.2
• /
• pp.138-142
• /
• 2012

Background : Electrical burns are one of the most devastating types of injuries, and can be characterized by the conduction of electric current through the deeper soft tissue such as vessels, nerves, muscles, and bones. For that reason, the extent of an electric burn is very frequently underestimated on initial impression. Methods : From July 1999 to June 2006, we performed 15 cases of toe tissue transfer for the reconstruction of finger defects caused by electrical burns. We performed preoperative range of motion exercise, early excision, and coverage of the digital defect with toe tissue transfer. Results : We obtained satisfactory results in both functional and aesthetic aspects in all 15 cases without specific complications. Static two-point discrimination results in the transferred toe cases ranged from 8 to 11 mm, with an average of 9.5 mm. The mean range of motion of the transferred toe was $20^{\circ}$ to $36^{\circ}$ in the distal interphalangeal joint, $16^{\circ}$ to $45^{\circ}$ in the proximal interphalangeal joint, and $15^{\circ}$ to $35^{\circ}$ in the metacarpophalangeal joint. All of the patients were relatively satisfied with the function and appearance of their new digits. Conclusions : The strategic management of electrical injury to the hands can be both challenging and complex. Because the optimal surgical method is free tissue transfer, maintenance of vascular integrity among various physiological changes works as a determining factor for the postoperative outcome following the reconstruction.

• Archives of Plastic Surgery
• /
• v.43 no.2
• /
• pp.134-144
• /
• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.1010-1014
• /
• 1997

Judet's rib struts which are designed for osteosynthesis are made of stainless steel This report describes clinical analysis of our experiences of 30 cases with the operative stabilization of multiple rib fractures with Judet's rib struts from December, 1995, to December, 1996 in Chungmoo Hospital, Chounan. Our indications for operative stabilization were as follows: 14 cases in flail chest, 8 cases in severe displacement of rib including segmental fractures, 7 cases in additional procedures during intrathoracic operation, and 1 case in other cause. Postoperative artificial ventilation is needed in only 1 case for 5 days and postoperative complications were few: 2 cases of hemopneumothorax, 2 cases of alcohol withdrawal delirium, and 1 case of postoperative hepatitis. Average duration of hospital admission who have limited thoracic injuries was 10.5 days. Though more comparative studies is necessary, we find this technique to be better than previously published m thods, since it provides better stabilization and immobilization of the ribs and shortening the duration of hospital admission.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.100-103
• /
• 2009

Traumatic rupture of the thoracic aorta is the second most common cause of death from motor vehicle accidents after head injury. About 85% of these patients do not survive to reach the hospital. The most common mechanism for this is deceleration injury, as occurs in a high speed motor vehicle accident. The aortic isthmus is the site of disruption for about 95% of all blunt thoracic aortic injuries. Another mechanism is crush injury which causes compression of the aorta between the displaced sternal body or manubrium and the thoracic vertebral column. These forces tear the inner layer of the aortic wall at an unusual location. We report here on a case of aortic arch dissection where the injury clearly occurred due to a crush injury and not because of deceleration. The surgical repair was delayed for 10 days after administering intensive medical therapy. The ascending aorta and aortic arch were replaced with an artificial graft with the patient under circulatory arrest and cerebral protection.