An appreciation of the normal variation of the Talar Tilt angle under stress roentgenogram on the ankle joint may throw some light on the diagnosis and treatment in an ankle joint injuries. The purpose of this study is to show the normal range of the Talar Tilt angleof the ankle joint under various circumstances and has been to compare the results of each angle. The author have undertaken the neutral ankle mortise view and inversion and eversion stress roentgenogram in all ankles and measured its Talar Tilt angle. The data were based on study of free chosen 50 normal Korean adult male 25 and female 25 respectively. The results were summerized as follows; 1. Talar Tilt angle was O degree in neutral ankle mortise view. 2. In inversion stress roentgenogram, Talar Tilt angle ranged from 0 to 15 degrees, 97% of cases were less than 10 degrees. 3. In eversion stress roentgenogram, Talar Tilt angle ranged from 0 to 7 degrees. 4. In inversion stress roentgenoram, the difference between right and left of same male and female ranged from 0 to 7 degrees. 5. It is very important to check accurately Talar Tilt angle under the same method and same conditions.
Adult ; Ankle Joint ; Ankle ; Diagnosis ; Female ; Humans ; Male ; Methods ; Reference Values

During the period from January 1980 to September 1988, 59 patients suffering from brachial plexus injury, have admitted to Seoul National University Hospital. Fifty-four patients were male and 5 patients were female, and age ranged from 6 to 58 years (mean:26.8 years). The most common cause of injury was traffic accident accounting for 66% (39patient), and among them 24 patients(62%) had the motor cycle accident. Birth injury, stab or gun shot wound, fall down and industrial hazard were following causes. Fracture and dislocation of involved limb accompanied in 19 patients(32%) and 2 patients of arterial injury were also found. EMG and cervicsl myelography with or without CT were performed in almost all the patients and MRI was performed in selected patients. Forty-five patients(76%) had supra-clavicular lesion and 14 patients (24%) had infra-clavicular lesion. In supra-clavicular lesion, upper roots or whole roots were involved in most of cases. Forty-nine cases were treated with conservative treatment for more than 8 months and operative procedures were performed in 36 cases. In operative cases, 30 patients were followed up for more than 1 year (average 24.3 months). Signs of root avulsion were found in 25 out of 31 cases of cervical myelography. MRI was performed in 7 cases, but it was inconclusive in diagnosis of root involvement. Infra-clavicular lesion showed better prognosis than supra-clavicular lesion. In supra-clavicular lesion, upper root involvement had the best prognosis. A pseudocyst detected by myelography usually precluded recovery in the root at the level of pseudocyst. Result of reparative treatment was better than that of conservative treatment. Overall satisfactory result in reparative treatment was 36%. However, if we include neurological improvement, positive result was 53%. Complete recovery was gained in half cases of neurolysis and other half showed no recovery, but all the cases of neurotization showed poor result. Reconstructive surgery including arthrodesis or muscle transfer can be effective treatment method, if it is performed properly on a selective patient.
Accidents, Traffic ; Arthrodesis ; Birth Injuries ; Brachial Plexus ; Diagnosis ; Dislocations ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Methods ; Myelography ; Nerve Transfer ; Prognosis ; Seoul ; Surgical Procedures, Operative ; Wounds and Injuries

The coronary artery fistula from right coronary artery to left ventricle is a rare disease among coronary artery anomaly. We experienced three cases of rare coronary fistula and report with literature review. Although symptoms of coronary artery fistula are associated with arteriovenous shunt and coronary steal phenomenon, many cases are asymptomatic. In this report, all patients had no symptom. but incidental murmur was noted (two are continuous, one is diastolic rumbling). The diagnosis was made by transthoracic or transesophageal echocardiogram and selective coronary angiography. Because patients were relatively young and the diameter of dilated coronary artery were huge, we perfomed operation on three patients.
Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Fistula* ; Heart Ventricles* ; Humans ; Rare Diseases

We present here, a case of pemphigus erythematosus developed in a 31-year-old woman, who had been suffering from repeated episode, of remission and exacerbation with several erythematous, and somewhat oozing patche accompanying a mild pruritus or her face, upper part of the back and anterior chest. In serological studies, she had antinuclear antiboc@lies at. a titer of 1:160. Histopathological finding showed subcorneal bullae. Immunofluorescent study revealed IgG and C, deposition in the intercellular space of the epidermis and along the de rmoepidermal junction.
Adult ; Epidermis ; Extracellular Space ; Female ; Fluorescent Antibody Technique ; Humans ; Immunoglobulin G ; Pemphigus* ; Pruritus ; Thorax

Nerve compression syndromes can be caused by compression of the peripheral nerve from interior or exterior of the nerve. In the upper extremities, brachial plexus, ulnar nerve and median nerve can be compressed in thoracic outlet syndrome, cubital tunnel syndrome and carpal tunnel syndrome respectively. Because these syndromes are caused by compression, decompressive management can be expected to be the principle of treatment. From Jan. 1980 to Dec. 1988, 94 patients were admitted and treated for nerve compression syndromes of the upper extremities in Seoul National University Hospital. Among these, 52 patients suffered from carpal tunnel syndrome and operation was performed to 86 hands. Twelve patients suffered from thoracic outlet syndrome and 25 from cubital tunnel syndrome. Ten patients were treated with conservative method and 84 with decompressive surgery. Satisfactory results were obtained in 92.3% of carpal tunnel syndrome and 84% of cubital tunnel syndrome. Of 4 operated cases of thoracic outlet syndrome, 3 cases were satisfactory.
Brachial Plexus ; Carpal Tunnel Syndrome ; Cubital Tunnel Syndrome ; Hand ; Humans ; Median Nerve ; Methods ; Nerve Compression Syndromes ; Peripheral Nerves ; Seoul ; Thoracic Outlet Syndrome ; Ulnar Nerve ; Upper Extremity

Thrombotic thrombocytopenic purpura(TTP) is characterized by fluctuating neurologic signs, microangiopathic hemolytic anemia, thrombocytopenia, fever and renal abnormalities. Neurologic involvement occurs in over 90% of patients with TTP. TTP is rarely associated with large intracerebral hemorrhage and peripheral neuropadiy. The authors report a case of TTP associated with large intracerebral hemorrhage confirmed by brain MRI and peripheral neuropathy diagnosed electrophysiologic findings and sural nerve biopsy.
Anemia, Hemolytic ; Biopsy ; Brain ; Cerebral Hemorrhage* ; Fever ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Peripheral Nervous System Diseases ; Purpura, Thrombotic Thrombocytopenic* ; Sural Nerve ; Thrombocytopenia

Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. A 17-year-old girl came to the hospital due to short stature, general weakness and galac-torrhea. The magnetic resonance imaging (MRI) study showed pitutary enlargement. The hormone study showed hyperprolactinemia, decreased basal growth hormone level and primary hypothyroi-dism. By thyroid replacement therapy only, mass was successfully regressed on follow up MRI after 4 months, and growth acceleration could be achieved.
Acceleration ; Adolescent ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Hyperplasia* ; Hyperprolactinemia ; Hypothyroidism* ; Magnetic Resonance Imaging ; Pituitary Gland ; Thyroid Gland

We report herein a case of pityriasis rubra pilaris in a 39-year-old male, who had erythematous scaly patches on the face, trunk and extremities for one year. The skin lesion showed well defined plaques on the elbow and knee joint areas, and exfoliative hyperkeratotic sheets with fissures on the palms and soles. He had no family and past history of such skin lesion. He was treated with etretinate lmg/kg/day for 1 week initially, and then tapered off 0.5mg/kg/day for 5 weeks with marked improvement. There was no exacerbation and recurrence of the skin lesion for about 1 year.
Acitretin* ; Adult ; Elbow ; Etretinate* ; Extremities ; Humans ; Knee Joint ; Male ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Recurrence ; Skin

Rhinocerebral mucormycosis, which is a fulminant and progressive disease often seen in debilitated hosts! Requires a high degree of clinical suspicion to promptly diagnose and an aggressive medical and surgical therapy. The prognosis is grave, especially in case of bilateral cavernous sinus thrombosis. We report a case of 69-year-old female patient with bilateral cavernous sinus thrombosis caused by rhinocerebral mucormycosis, who showed orbital swelling and lateral bulging of bilateral cavernous sinus in orbital CT, and large branching nonseptate hypae in biopsed specimen of the left periorbital necrotic tissue.
Aged ; Cavernous Sinus Thrombosis ; Cavernous Sinus* ; Female ; Humans ; Mucormycosis* ; Orbit ; Prognosis

We report a case of classic Kaposi's sarcoma (KS) in a 67-year-old man, who had multiple cutaneous lesions of the feet and left hand as well as an internal involvement of the stomach. The histopathologic findings showed typical features of KS as a mid-dermal tumor composed of vascular proliferations, vascular slits, spindle cells, extravasated erythrocytes and deposits of hemosiderin. Analysis of T-cell subpopulations showed decreased T4 lymphocytes and in-creased T8 lymphocytes; the ratio of T4M lymphocytes was decreased. Natural killer cell activity was also decreased. These findings suggest a possible relationship between immunological abnormalities and the pathogenesis of this disease. The patient's serum was negative for antibodies to the human immunodeficiency virus (HM). This report describes a case of classic KS with immunological abnormalities and internal involvement and possible pathogenetic mechanisms are discussed.
Aged ; Antibodies ; CD4-Positive T-Lymphocytes ; CD8-Positive T-Lymphocytes ; Erythrocytes ; Foot ; Hand ; Hemosiderin ; HIV ; Humans ; Killer Cells, Natural ; Lymphocytes ; Sarcoma, Kaposi* ; Stomach ; T-Lymphocytes