BACKGROUND: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. METHODS: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24–105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. RESULTS: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. CONCLUSIONS: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.
Follow-Up Studies ; Humans ; Humerus* ; Incidence ; Ligaments ; Magnetic Resonance Imaging ; Ontario ; Orthopedics ; Shoulder Dislocation* ; Shoulder* ; Surgeons ; Tears

Cecal Diverticulitis(CD) is a rare condition with a higher incidence in Oriental populations, which symptoms and signs are closely simulate acute appendicitis. The present study was designed to resume the optimal therapeutic modalities. A retrospective review was conducted between 1991 and 1996 on 28 surgically treated patients(18 men, 10 women ; mean age 45 years) with documented CD in Kon-Kuk University Hospital. Most patients presented with right lower quadrant pain and tenderness. Acute appendicitis was the preoperative diagnosis in 89.2%(25/28) of the patients. The CD patients were divided into three groups : CD-RC(right hemicolectomy group; n=4), CD-DV(diverticulectomy group; n=5), and CD-AP(appendectomy only group; n=19) by operative options. Information on patient demographics, duration of symptom, white blood cell count, radiologic studies, operative procedure, operation time, hospital days, duration of intravenous antibiotics administration, complications and recurrent symptoms were reviewed and analyzed. CD-RC and CD-DV patients required more hospital days than CD-AP(mean 20.6 days, 9.6 days versus 8.4 days, respectively) and more complications(50%, 60% versus 26%). There was no recurrent patient in this series and also there were no reoperated cases. But there was one death in CD-RC group. Of the 4 patients who had right hemicolectomy, one was expired by sepsis and one had minor wound infection. Minor wound infections are the most common complications : 5 in CD-AP, 3 in CD-DV group. Conclusively, if CD could be diagnosed preoperatively, surgical management should be reserved and initial medical treatment with intravenous antibiotics should be considered, and in those patient who underwent emergency operation presumed acute appendicitis, right hemicolectomy with primary ileocolic anastomosis is recommended with acceptable low morbidity. But alternatively appendectomy only is a safe and effective procedure for the treatment of CD if there is no evidence of free perforation, abscess formation or strongly suggested cecal carcinoma.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Demography ; Diagnosis ; Diverticulitis* ; Emergencies ; Female ; Humans ; Incidence ; Leukocyte Count ; Male ; Retrospective Studies ; Sepsis ; Surgical Procedures, Operative ; Wound Infection

No Abstract available.
Presbycusis* ; Risk Factors*

Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

Femoral fractures in adults frequently need an extensive dissection for attainment of adequate internal fixation, frequently leading to nonunion, infection and derangement of joint motion. Retrograde IM nailing, compared to the conventional methods, has advantages of reducing periarticular soft tissue dissection and establishing a load sharing construct reducing hardware failure. The purpose of this study is to verify the advantages of retrograde IM nailing by retrospective evaluation of the results of adult femoral fractures treated by this technique. The matrials were 17 femoral fractures in 15 patients treated by retrograde IM nailing and followed up for more than 1 year. The fracture was located in the middle third of the shaft in 5 and distal third in 12. The latter consisted nf 6 cases of type Al, 4 cases of type A2 and 2 cases of type A3 by Miiller's classification. The results were as follows; 1) Fracture union was achieved at an average of 17.5 weeks. 2) Full range of knee motion was gained in 15/17 knees (88%). 3) Complication occurred in 2 knees. One nonunion and one angulatory malunion. 4) There was no infection, no femoral shortening or implant failure. In conclusion, retrograde IM nailing of adult femoral fracture is an effective method in selected cases such as far distal femoral fracture, ipsilateral femur neck and shaft fractures, floating knee, post-TKR femoral fracture and so on. The merits of this technique are rigid fixation which is difficult to obtain with others, no need of fracture table, short operative time and mimium blood loss. However, It has potential problems such as difficulty in insertion of proximal locking screw and need for an arthrotomy to remove hardware.
Adult* ; Classification ; Femoral Fractures ; Femur ; Femur Neck ; Fracture Fixation, Intramedullary* ; Humans ; Joints ; Knee ; Operative Time ; Retrospective Studies

Acute autonomic and sensory neuropathy (AASN) is very rare immune mediated neuropathy characterized by prominent dysautonomia and sensory involvement without motor weakness. Most of AASN patients have a rapid onset reaching its worst within four weeks like Guillain-Barré syndrome. The treatment response is variable. Recently, we experienced a patient diagnosed as AASN with progressive autonomic and sensory symptoms more than 1 year, and showed good response in immunotherapy.

PURPOSE: Process management is the activity which manages all procedure of construction by representing visually interrelation of operation or sequence setting. The purpose of this study was for reducing treatment period and higher efficiency of treatment through application of PERT/CPM (Program Evaluation & Review Technique/Critical Path Method) in dental clinic. MATERIALS AND METHODS: The patients were selected for study who needed more than 2 departments' cooperation for prosthodontic treatment in Wonkwang Dental University Hospital. Control group is composed of the patient's whole treatment plan, treatment period, numbers of hospital visit, treatment costs, treatment results. On the other hand, experiment group contains the patient's virtual treatment data based on PERT/CPM technique. We applied PERT/CPM in operation analysis. RESULTS: Treatment period, numbers of hospital visit was decreased as 18.1% and 15.3% when we applied operation analysis based on charts. Also treatment cost in experiment group was 0.9% economized compared with control group's treatment cost. CONCLUSION: Application of PERT/CPM in dental clinic can achieve reliable treatment and reduced treatment period and establish plan of minimum treatment cost.
Dental Clinics ; Hand ; Health Care Costs ; Humans ; Prosthodontics

This etiology of Freiberg's disease, an idiopathic avascular necrosis of the second metatarsal head, has not been clarified. In 1979, Gauthier and Elbaz treated 53 cases of the advanced Freiberg's disease by a new technique, that is, dorsal closing wedge osteotomy, and their result was successful. Recently, in 1989, Zollinger identified that the load per surface area is concentrated at the dorsal rather than plantar surface of the second metatarsal head during walking by an experimental dynamic study, and this theory explained why the lesion of the disease is confined to the dorsal surface of the second metatarsal head, and provided a basic concept on the dorsal closing wedge osteotomy. The authors reviewed 5 cases of Freiberg's disease treated by dorsal closing wedge osteotomy from September 1989 to February 1994, and the average follow-up period was 2 years and 5 months(range, 12 to 50 months). The results were as follows; 1. All were female, and the average age at the time of operation was 29.4 years(range, 22 to 43 years). 2. All were pain-free at the last follow-up. 3. The range of motion(ROM) of the metatarsophalangeal joint was increased postoperatively; average ROM: preoperative, 33°/ postoperative 77°; mean gain of ROM, 44° So, dorsal closing wedge osteotomy is a recommendable procedure for the treatment of advanced Freiberg's disease.
Female ; Follow-Up Studies ; Head ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Necrosis ; Osteotomy ; Walking

BACKGROUND: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. METHODS: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24–105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. RESULTS: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. CONCLUSIONS: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.
Follow-Up Studies ; Humans ; Humerus ; Incidence ; Ligaments ; Magnetic Resonance Imaging ; Ontario ; Orthopedics ; Shoulder Dislocation ; Shoulder ; Surgeons ; Tears

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that occurs once in 3,000 live births. Patients with NF1 are prone to develop malignancies, particularly neural tumors, that is, malignant schwannoma and glioma in adults. For non-neural tumors, the NF1 incidence is increased in rhabdomyosarcomas, leukemia, malignant melanomas, breast cancer, lung cancer, thyroid cancer, and other organ cancers. The NF1 gene seems to increase the risk for carcinogenesis. A case of NF1 associated with metachronous cancers, such as breast cancer (1991) and small-bowel leiomyosarcoma (1997), in the same patient is reported. Investigation of the patient's family revealed four further cases (offsprings) of multiple neurofibromatosis. The relevant literature on the subject is reviewed.
Adult ; Breast Neoplasms ; Carcinogenesis ; Genes, Neurofibromatosis 1 ; Glioma ; Humans ; Incidence ; Leiomyosarcoma ; Leukemia ; Live Birth ; Lung Neoplasms ; Melanoma ; Neurilemmoma ; Neurofibromatoses ; Neurofibromatosis 1* ; Rhabdomyosarcoma ; Thyroid Neoplasms