The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI.MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded.Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes.In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.
Langerhans` Cell Histiocytosis (LCH) is a rare disease involving proliferation of Langerhans-type cells, which shares immunophenotypic and ultrastructural similarities. In this article, we report a case of Langerhans cell histiocytosis in solitary involvement of clavicle of adult male. A 21-year-old male visited outpatient department on account of solitary palpable tumorous lesion in right clavicle. The lesion was found 2 weeks before the visit, and it triggered pain but no tenderness. Findings on X-ray, and CT were suggestive of homogeneous osteolytic lesion of the clavicle, and hot uptake was found in right clavicle on bone scan which is commensurate with site of the lesion. Based on findings on MRI, Ewing's sarcoma, osteomyelitis and malignant hematologic malignancies were initially suspected for differential diagnosis. For the purpose of excision and histologic analysis, excisional biopsy was performed. Biopsy concluded with diagnosis of LCH. LCH is widely renowned for its frequent occurrence in pediatric ages, and it occurs usually between ages of one and four. It occasionally occurs in adults. LCH in skeletal system usually involves cranium, vertebrae, rib and so forth. It is very rare for LCH to occur exclusively in clavicle when it involves skeletal system. For diagnosis of LCH, sole imaging studies are inadequate, and histologic, immunochemical analyses are confirmative modalities. Treatment of LCH is not currently standardized. Most of the solitary tumorous lesions in clavicle in adults call for various differential diagnoses. LCH should be considered in the diagnosis of a adult patient with a clavicle mass.
Study Design: A retrospective study Objective: To categorize and analyze clinical results of degenerative lumbar deformity patients according to the degree of scoliosis and kyphosis. Summary and Literature Review: A degenerative spinal deformity is classified into a coronal and sagittal deformity. There are some reports about treatment according to each classification but the classification is sometimes inappropriate and the treatment can vary. Materials and Methods: From June 1998 to June 2003, 79 patients, who were diagnosed with a degenerative lumbar deformity and underwent conservative or operative treatment, were studied retrospectively. Group I had scoliosis ranging from 10 to 20。, and group II had scoliosis �20。Each group was subdivided into A, B, and C according to the lordosis, group A �30。, group B between 20 to 30。, and group C �20。. Scoliosis and lordosis were measured from the radiographs and the clinical results were evaluated using the Kirkaldy-Willis criteria and VAS score before and after surgery. Results: In group I, 9 cases underwent surgery and 11 cases underwent conservative treatment, without any significant differences in the clinical results. In group II, 35 cases underwent surgery and 24 cases underwent conservative treatment. Excellent results were obtained in 18(51.4%) cases, good in 15(42.9%) and 2(5.7%) were below fair. The average VAS score in group II given conservative treatment 8.9 preoperatively and 6.5 at the final follow up. Tn group II given surgical treatment the average VAS score was 9.2 preoperatively and 4.1 at the final follow up. There was a significant difference in the outcome (P�0.05). Conclusion: Patients with a degenerative lumbar deformity with accompanying lumbar scoliosis and kyphosis, scoliosis �20。or lordosis �20。are expected to show more improvement in symptom after surgery than after conservative treatment.
Background: The purpose of this study was to determine whether there is any advantage for a continuous background infusion during patient controlled epidural analgesia(PCEA) for postoperative pain control. Methods: 60 patients scheduled for elective cesarean section under epidural anesthesia were assigned randomly in a double-blind fashion to receive fentanyl and bupivacaine by PCEA with or without background infusion for 48 hours postoperatively. Results: Total amount of fentanyl and bupivacaine consumption and degree of sedation were not significantly different between the two groups. Visual analogue scale(VAS) pain scores at 24, 36, and 48h and sleep disturbance were significantly lower in background infusion group. Conclusion: Administration of fentanyl with bupivacaine by continuous background infusion is appropriate for PCEA for postcesarean section pain control.
Background: Epidural steroid injection(ESI) is often adminstered to treat lower back pain, but its effect iveness on postepidural backache have not yet been determined. Methods: Sixty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to receive, 1 ml of normal saline(Group 1), or 5 mg of dexamethasone (Group 2), epidurally via indwelling catheter after delivery. Results: The incidences of postepidural backache occured significantly more often in Group 1(56.7%) than in Group 2(26.7%)(P
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