Purpose: This study assessed the results of surgical treatment for Neer type-II and type-V unstable distal clavicle fractures via hybrid fixation with a locking compression plate and finger trap wire. Materials and Methods: From September 2016 to April 2018, 15 patients treated for Neer type-II and type-V unstable distal clavicle fractures using hybrid fixation were analyzed retrospectively. The clinical results were analyzed based on the radiological healing time, range of motion of the shoulder joint, American Shoulder and Elbow Society (ASES) score, and the University of California at Los Angeles (UCLA) shoulder score. Results: The range of motion of the shoulder joint completely recovered to the normal range within 9.2 weeks on average (6−24 weeks). Furthermore, the follow-up of the clinical trial showed excellent results, including an ASES score of 98.5±2.3 and an UCLA score of 34.2±1.3. In addition, fracture union was successfully achieved in all cases, and was identified during week 15 on average. Conclusion For the treatment of unstable distal clavicle fractures, hybrid fixation is a useful surgical method with excellent clinical outcomes through rapid recovery of the range of motion of the shoulder joint after surgery.

Cutaneous metastases from Internal carcinomas are relatively rare. We report a case of cutaneous metastasis believed t.o originate from primary lung carcinoma in a 69-year-old male patient. The patient presented with localized well defined multiple variable sized, hard eryt,hematous papules, nodules and pustules on the right chest, back and upper arm. Biopsy specimens from the nodules upper chest revealed scatt,ered islands of tumor cells and fi brosis of the dermis. To evaluate the role of p53 protein in the development of skin tumors, we examed p53 expres sion at protein level by imnunoperoxidase stain using monoclonal antimouse human p53 antibody on paraffin embeded tissues The patient died after four months from the appearance of cutaneous lesions.
Aged ; Arm ; Biopsy ; Dermis ; Humans ; Islands ; Lung ; Male ; Neoplasm Metastasis ; Paraffin ; Skin ; Thorax

Mycoplasma pneumoniae pneumonia is one of the most prevalent community-acquired pneumonias in pediatric patients. It commonly presents with mild respiratory symptoms and is well controlled by macrolide antibiotics. Rarely, it can progress to acute respiratory distress syndrome (ARDS) despite appropriate antibiotic therapy, and systemic corticosteroids and quinolone antibiotics are required. We recently treated 2 patients who presented with M. pneumoniae pneumonia with ARDS. Case 1: A 17-year-old girl was admitted with pneumonia that showed no response to antibiotics and progressed to ARDS, which required initiation of mechanical ventilation therapy. The patient was negative for M. pneumoniae IgM; but positive for, M. pneumoniae. After treatment with methylprednisolone and levofloxacin, rapid improvement was observed in both clinical manifestations and chest radiographic findings. Two days after discontinuing a 5-day methylprednisolone treatment regimen, she developed fever, and investigations revealed an elevated C-reactive protein level; this necessitated additional methylprednisolone treatment. Subsequently, she showed complete recovery with no sequelae. Case 2: A 14-year-old girl was admitted with M. pneumoniae pneumonia with ARDS that required mechanical ventilation therapy. She showed a IgM titers against M. pneumoniae of 1:320. After treatment with antibiotics and methylprednisolone, she recovered and was discharged at 48 admission days; however, mild dyspnea persisted. The chest computed tomography showed multiple bronchiectasis areas. After 15 days, because of aggravated dyspnea, she was readmitted and adminis-tered methylprednisolone pulse therapy. Despite 3 courses of methylprednisolone pulse therapy, she still showed mild dyspnea.
Adolescent ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Bronchiectasis ; C-Reactive Protein ; Child ; Dyspnea ; Female ; Fever ; Humans ; Immunoglobulin M ; Levofloxacin ; Methylprednisolone ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Thorax

PURPOSE: The objective of this study was to evaluate an immunoassay for urinary nuclear matrix protein (NMP22) as an indicator for transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Three groups of subjects attended the trial of NMP22. First group was 27 patients with transitional cell carcinoma of the bladder, second group was 24 patients with other urinary cancer consisted of prostate cancer and renal cell carcinoma, and third group was 24 healthy volunteers. NMP22 was determined using a commercial test kit, which is based on an enzyme-linked immunosorbent assay. RESULTS: In normal healthy volunteers and other urinary cancer group median NMP22 levels were 2.24 and 3.27 U/ml, respectively. Median urinary NMP22 levels in patients with transitional cell carcinoma of the bladder were 54.30 U/ml. It was significantly greater than other two groups. Median NMP22 levels according to the tumor stage and the tumor grade did not show the significant difference statistically. CONCLUSIONS: Urinary NMP22 is a useful marker that is more specific for bladder cancer thsn for other urinary cancer. Further tests are required to clarify the influence of other spe- cific conditions, such as urinary tract infection, and intravesical drug instillation or procedure.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell* ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Immunoassay ; Instillation, Drug ; Nuclear Matrix* ; Prostatic Neoplasms ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections

The earliest reports of the use of electrical energy to directly stimulate bone healing seem to be in 1853 from England, the techniques involved the introduction of direct current into the non-united fracture site percutaneously via metallic needles, with subsequent healing of the defect. One endpoint of the periodontal therapy is to generate structure lost by periodontal diseases. Several procedural advances may support regeneration of attachment, however, regeneration of alveolar bone does not occur consistently. Therefore, factors which stimulate bone repair are areas for research in periodontal reconstructive therapy. Effects of cytokines or growth factors on bone repair are examples of such areas. Another one is electrical current which occurs in bone naturally, so that such bone may be particularly susceptible to electrical therapy. The purposes of this study were to observe the effects of electrical stimulation on the normal periodontium, to determine whether the electricity is the useful means for periodontal regeneration or not. Forty rats weighted about 100 gram were used and divided into 4 groups, the first group, there was no electrical stimulation with the connection of electrodes only. In the second group, there was stimulated by the 10 mA during 10 minutes per a day, in the third group was stimulated by the 25 mA , and the fourth by the 50 mA. At 3, 5, 10 and 15 days post-appliance , two rats in each group were serially sacrificed. and the maxillae and the mandible processed to paraffin, and the specimens were prepared with Hematoxylin-Eosin stain for the light microscopic evaluation. The results of this study were as follows : 1. There was the distinct reversal line on the lingual alveolar crest, whereas a little changes in the labial alveolar crest to the duration and amount of currents. 2. In 50 mA group, the cells were highly concentrated at the apex of anterior teeth, and was observed the necrotic tissue. In posterior root apex, the hypercementosis was appeared, and newly formed cementum layer has been increased continuously with the time. 3. The periodontal ligament fiber and Sharpey's fiber were arranged in order, and the bone trabeculae were increased as the experiment proceeded by, relatively the bone marrows were decreased. 4. In the pulp tissue, the blood vessels were increased with blood congestion in the experimetal specimens remarkably, and the dentinal tubules were obstructed . 5. The osteoblasts in alveolar bone proper had been showed highly activity, and also observed the formation of bone trabeculea. In the conclusion, it was suggested that the electrical stimulation has influence on the periodontium and the pulp tissue. However, there might be the injurious effects.
Animals ; Blood Vessels ; Bone Marrow ; Cytokines ; Dental Cementum ; Dentin ; Electric Stimulation* ; Electricity ; Electrodes ; England ; Estrogens, Conjugated (USP) ; Hypercementosis ; Intercellular Signaling Peptides and Proteins ; Mandible ; Maxilla ; Needles ; Osteoblasts ; Osteogenesis ; Paraffin ; Periodontal Diseases ; Periodontal Ligament ; Periodontium* ; Rats ; Regeneration ; Tooth

Neurofibromatosis type1(von Recklinghausen's disease) is characterized by multiple skin tumors and abnormal cutaneous pigmentation(cafe au lait spots). Unlikely the solitary neurofibroma, those encountered in von Recklinghausen's disease may cause significant morbidity. The vasculopathy, although poorly recognized manifestation of von Recklinghausen's neurofibromatosis is a major cause of fatal cases. One of its most dramatic presentation is the spontaneous hemothorax. We report a case of Von Recklinghausen's disease with multiple neurofibromatosis accompanying intrathoracic hemorrhage due to vascular rupture, which is the first legal autopsy case in korea.
Autopsy ; Death, Sudden* ; Hemorrhage ; Hemothorax ; Humans ; Korea ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Rupture ; Skin

INTRODUCTION: Most of the palatal fistulas develop along the suture line in a small size, so they can be corrected easily by re-palatoplasty or various flap surgery using the local mucoperiosteum. But it is very difficult to repair if the fistula is very large or located anterior to the hard palate. Buccal mucosal or vestibular mucosal flaps may settle the problems but there are many limitations on the size and location. And other extraoral distant flaps need not only many surgical steps but also cause inconvenience. But tongue flap proffers as an excellent method for the repair of large anterior palatal fistula because of highly mobility and rich blood supply and low donor site morbidity. MATERIALS & METHODS: We treated the six cases of large palatal fistulas using the distally based tongue flap. We dissected under the submucosa layer around fistula site preserving the mucoperiosteum and the elevated flap was rotated to nasal side and sutured with 4-0 Vicryl(R) for the repair of the nasal side. And then we elevated the tongue flap on the distal portion of the tongue. The elevated tongue flap was placed on the defect area and sutured with 4-0 Chromic(R). After 2 or 3 weeks, we detached the tongue flap which was placed on the fistula site. Donor site was closed with 4-0 Chromic(R). RESULTS: The mean size of palatal fistula was 7.2 cm. All of patients complained the discomforts in masticating and speaking before flap detaching operation. A wound dehiscence was observed on tongue flap sutured to defect site. But it was healed by revisionary suture. There was no donor site complication. CONCLUSION: The authors propose that the distally based tongue flap is an excellent method for the repair of large palatal fistula because of its highly mobility, rich blood supply, and few of donor site morbidit
Fistula* ; Humans ; Palate, Hard ; Sutures ; Tissue Donors ; Tongue* ; Wounds and Injuries

PURPOSE: The number of sore patients are increasing steadily, especially in old ages, chronic disease and paralytic patients. Most of patients need to surgical treatment. The aim of this paper is to assess clinical analysis of surgical treatment and to consider operative methods, complications, and recurrences. METHODS: We reviewed the data from 82 consecutive patients with 101 pressure sores from March 2003 to May 2006 to discuss the occurrence rate and recurrence rate according to the site on the basis of the presence or absence of paraplegic and its etiology-the patients were categorized into three diagnostic groups: traumatic paraplegics(TP), nontraumatic paraplegics (NTP), and nontraumatic nonparaplegics(NTNP). We examined the sites and sizes of each lesions, patient's state, primary causes of pressure sore, operative methods as each sites and groups, occurrence of complications and recurrences on each groups. RESULTS: In 82 patients, 52 patients were male, 30 patients were female. The male to female ratio was 1.7 :1. Mean age was 55.8 years. 27 patients were in TP group, 35 in NTP group, and 20 in NTNP group, respectively. The common site of sore were sacral area (50.5%), greater trochanteric area(15.8%) and ischial area(13.9%). In each group, incidence rate of recurrence and complication were 11.1%, 40.7% in TP, 5.7%, 5.7% in NTP and 15%, 45% in NTNP. CONCLUSION: Surgeons must consider the general condition of the patient and possibility of recurrence and returning of daily life. We propose that cutaneous flap, fasciocutaneous flap or skin graft as well as musculocutaneous flap be useful to repair of sore site as each patient's state.
Chronic Disease ; Female ; Femur ; Humans ; Incidence ; Male ; Myocutaneous Flap ; Pressure Ulcer* ; Recurrence ; Skin ; Transplants

PURPOSE: The key points of treatment of cryptotia are the elevation of invaginated ear helix and the correction of deformed cartilage. Prevention of stabilized cartilage contouring from returning to the previous state is also important. The authors carried otoplasty by modified Onizuka's method or Ohmori's method that conchal cartilage graft or high density polyethylene implant(MEDPOR(R)) graft served as fixation after spreading posterior aspect of adhered antihelix and a splint for prevention of recurrence of cartilage deformities. The aim of this study is to reveal the availability of the high density polyethylene implant(MEDPOR(R)) graft for the correction of cryptotia. METHODS: We have repaired 17 cryptotic deformities using cartilage graft from cavum of concha(12 cases) or high density polyethylene implant(5 cases) for correction of deformed cartilage. We investigate the operative time, complications, and satisfaction of postoperative ear shape on both autogenous cartilage graft group and high density polyethylene implant graft group. RESULTS: There was 1 case of reinvagination on autogenous cartilage graft group. Implant exposure was occurred on high density polyethylene implant graft group, as 1 case. These were statistically no differences between autogenous cartilage graft group and high density polyethylene implant graft group to the satisfaction of ear shape. CONCLUSION: High density polyethylene implant (MEDPOR(R)) present an alternative to autogenous material as they allow of fibrovascular ingrowth, leading to stability of the implant and decreased infection rates. The correction of deformed cartilage by using the high density polyethylene implant(MEDPOR(R)) is a good option for the treatment of cryptotia.
Cartilage ; Congenital Abnormalities ; Ear ; Operative Time ; Polyethylene ; Recurrence ; Splints ; Transplants

Tufted angioma is an uncommon, slowly-progressive vascular tumor, found typically in infants, young children and sometimes at birth or during adulthood. It shows a characteristic histopathologic finding, the so-called "cannonball" appearance. Various tumors can be developed in the nevus flammeus, such as pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, giant proliferative hemangioma and lymphangioma circumscriptum. Tufted angioma can be also accompanied with nevus flammeus and the coexistence of tufted angioma and nevus flammeus is a very rare condition. We report a case of tufted angioma arising within nevus flammeus in the left axilla of a 47 year-old female.
Axilla ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Child ; Female ; Granuloma, Pyogenic ; Hemangioma* ; Humans ; Infant ; Lymphangioma ; Middle Aged ; Nevus* ; Parturition ; Port-Wine Stain*