Dislocation involving tarsal navicular is a extremely rare injury compare to dislocation of other tarsal bone. One case of the tarsal navicular dislocation associated with subluxation of the midtarsal joint treated by open reduction and arthrodesis was reported.
Arthrodesis ; Dislocations ; Joints ; Tarsal Bones

The carpal tunnel syndroms is the most common peripheral nerve entrapment syndrome. The typical symptom is pain, numbness and paresthesia in the median nerve territory of the hand and progressive thenar atrophy. When the symptom is mild and its duration is short, conservative treatment such as splinting or local steroid injection is considered, but when neurological deficit is promiment and conservative treatment is not effective, surgical decompression is indicated.Authors reviewed 15 patients (23 cases) of carpal tunnel syndrome treated with surgical decomression at the Department of Orthopedic Surgery, Kyung-pook National University Hospital from March 1983 to October 1988. The follow up results are as follows; 1. Preoperatively, Tinel sign was present in 17 cases. Phalen test was positive in 17 cases. Sensory disturbance was present in 8 cases. Thenar muscle atrophy was present in 19 cases. Motor weakness was present in 13 cases. 2. Preoperatively, delay of motor conduction velocity of median nerve was noted in 15 cases (65.2%) and sensory nerve conduction velocity in 20 cases (86.9%). Denervation findings such as fibrillation or sharp waves were seen in 15 cases (65.2%). 3. The operative findings were as follows; Synovial hypertrophy in 12 cases, hypertrophy of transcarpal ligament in 4 cases, pseudoneuroma in 3 cases, ganglion in 2 cases, neurilemmoma in 1 case, gout in 1 case. 4. As the operative findings, median nerve had evidence of compression beneath the transcarpal ligament, consisting of flattening. narrowing and decreased epineurial vascularity. 5. External neurolysis was performed in all cases. 6. In case of long duration and severe thenar atrophy, internal neurolysis would be recommendable. 7. Fllow up period was ranged from 7 months to 6 years. 8. 19 cases (82.6%) were excellent or good results.
Atrophy ; Carpal Tunnel Syndrome ; Decompression, Surgical ; Denervation ; Follow-Up Studies ; Ganglion Cysts ; Gout ; Hand ; Humans ; Hypertrophy ; Hypesthesia ; Ligaments ; Median Nerve ; Muscular Atrophy ; Neural Conduction ; Neurilemmoma ; Orthopedics ; Paresthesia ; Peripheral Nerves ; Splints

Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

OBJECTIVE: We investigate and compare geometric patterns and degree of p53 protein expression in a peri-infarction area between two different types of cerebral infarction, delayed and completed focal cerebral infarctions. METHODS: For the delayed focal cerebral infarction group(Group 1 ; n=8), right middle cerebral artery(MCA) and bilateral common carotid artery(CCA) were ligated temporarily for thirty minutes, and their brains were obtained after 72 hours. For the completed focal cerebral infarction group(Group2 ; n=11), right MCA and CCA were occluded permanently, and contralateral CCA was occluded for thirty minutes, and their brains were obtained after 24 hours. RESULTS: The infarction volume was significantly larger in Group 2(267.2+/-29.6mm3) than that of Group 1(10.4+/-2.7mm3)(p<0.001). The width of p53 protein positive area was significantly longer in Group 1(107.8+/-60.5micro meter) than that in Group 2(75.0+/-7.1micro meter)(p<0.05). The density of p53 positive cell was more compact in group 2(48.2+/-1.7cells/HPF) than group 1(28.3+/-9.1cells/HPF)(p<0.001). CONCLUSION: It is suggested that the decreased p53 protein expression in the delayed infarction has certain roles other than apoptosis. The degree of p53 protein expression in the completed focal cerebral infarction seems to be closer to a critical level of gene expression that might determine cell death.
Animals ; Apoptosis ; Brain ; Cell Death ; Cerebral Infarction* ; Gene Expression ; Infarction ; Rats*

BACKGROUND AND OBJECTIVES: This study was undertaken to evaluate the effect of superior cervical ganglionectomy (SCG) on anosmia, which is peripherally induced in the mice. MATERIALS AND METHOD: Three groups of mice (BCF1) were studied: normal control (nasal instillation of saline, n=6); zinc sulfate group (nasal instillation of 64 mM zinc sulfate, n=25); SCG group (superior cervical ganglionectomy after nasal instillation of 64 mM zinc sulfate, n=25). Tissues of olfactory mucosa were obtained at 1, 2, 3, 4 and 7 weeks after instillation of zinc sulfate, and processed for immunohistochemistry using antisera to olfactory marker protein (OMP) to evaluate the olfactory regeneration. RESULTS: No OMP-positive cells were observed in the first two weeks after the instillation of zinc sulfate in both zinc sulfate group and the SCG group. However, the OMP-positive cells appeared first at 3 weeks after the instillation in both groups, and gradually increased in number at 4 and 7 weeks. In the SCG group, the increase of OMP-positive cells was significantly greater than those of the zinc sulfate group. The number of OMP-positive cells in the SCG group at 7 weeks was almost similar to that of the normal control group. CONCLUSION: SCG enhances regeneration of olfactory receptor cells at 3 weeks after injury. It was inferred from the above results that SCG has a significant effect on the regeneration of olfactory receptor cells and we suggest that SCG could be an effective treatment modality for olfactory dysfunction.
Animals ; Autonomic Nerve Block ; Ganglionectomy* ; Immune Sera ; Immunohistochemistry ; Mice* ; Olfaction Disorders ; Olfactory Marker Protein ; Olfactory Mucosa ; Olfactory Receptor Neurons ; Regeneration ; Smell* ; Zinc Sulfate

PURPOSE: To know biomechanical differences in methods of limb lengthening between using monolateral external fixator and using external fixator over an intramedullary nail. MATERIALS AND METHODS: In acryl rods, saw-bone, and cadeveric bone, we created two lengthening models of using monolateral external fixator and using external fixator over an intramedullary nail. The axial compression test was done on the site of osteotomy for lengthening. To fix the models, half pins of 5 mm in diameter and nails of 9 mm in diameter were used. Using MTS (Material Test System) machine, we evaluated the differences of axial stiffness according to the presence of an intramedullary nail or the numbers of half-pins which were fixed at each side of osteotomy. RESULTS: Lengthening over an intramedullary nail, comparing to monolateral external fixator only, increased the axial stiffness by 1.1~1.2 times in acryl rods, 1.2~1.6 times in saw bones, and 15.6~15.9 times in cadeveric bones when the same numbers of half-pins were used. In saw bone and cadaveric bone, the group of two half pins in lengthening over an intramedullary nail was stiffer than the group of three pins in lengthening with monolateral external fixator. CONCLUSION: In the distraction of the limb, the addition of an intramedullary nail may increase the axial stiffness of the frame of monolateral external fixator. In lengthening over an intramedullary nail, it is enough to distract the bone with fixing two half pins at each sides of osteotomy.
Cadaver ; External Fixators* ; Extremities ; Osteotomy

BACKGROUND AND OBJECTIVES: It has been known that the dominant driver of atrial fibrillation (AF) exists in the left atrium (LA) and the incidence of systemic thromboembolism is higher than that of pulmonary thromboembolism in patients with AF. Therefore, we hypothesized that histological and biochemical characteristics of the LA and the right atrium (RA) are different in patients with mitral valvular AF. SUBJECTS AND METHODS: We analyzed the histology and messenger ribonucleic acid (mRNA) or protein expression associated with endothelial function and thrombogenesis in 33 human atrial appendage tissues (20 LA tissues, 13 RA tissues) taken from 25 patients {57.7+/-11.3 years old, 44% males, AF: sinus rhythm (SR)=17:8} with mitral valve disease. We also performed whole mRNA quantification in 8 tissues (both LA and RA tissues from 4 patients) by using next generation sequencing (NGS). RESULTS: 1) The degree of fibrosis (p=0.001) and subendocardial smooth muscle thickness (p=0.004) were significantly greater in the LA than in the RA. 2) More advanced matrix fibrosis was found in the LA of patients with AF than in the LA of patients with SR (p=0.046), but not in the RA. 3) There was no LA-RA difference in protein (Western blot) and mRNA {quantitative real-time polymerase chain reaction (qRT-PCR)} expressions of NF-kappaB, 3-NT, CD31, E-selectin, inducible NO synthase, stromal cell-derived factor-1alpha, Endothelin-1, platelet-derived growth factor, myeloperoxidase, or NCX, except for higher mRNA expression of HCN4 in the RA (qRT-PCR, p=0.026) and that of KCNN1 in the LA (NGS, p=0.016). CONCLUSION: More advanced matrix and subendocardial remodeling were noticed in the LA than in the RA in patients with mitral valvular AF. However, the expressions of tissue factors associated with thrombogenesis were not significantly different between the RA and the LA.
Atrial Appendage ; Atrial Fibrillation* ; Chemokine CXCL12 ; E-Selectin ; Endothelin-1 ; Fibrosis ; Heart Atria* ; Humans ; Incidence ; Male ; Mitral Valve ; Muscle, Smooth ; NF-kappa B ; Nitric Oxide Synthase ; Peroxidase ; Platelet-Derived Growth Factor ; Pulmonary Embolism ; Real-Time Polymerase Chain Reaction ; RNA ; RNA, Messenger ; Thromboembolism ; Thromboplastin

BACKGROUND: Cholecystectomy is the standard treatment for gallbladder stones and at present is performed in minimally invasive procedures. There are several advantages to a laparoscopic cholecystectomy, so now it is a popular procedure for use in a cholecystectomy. Also, a minilaparotomy cholecystectomy is an alternative method to a traditional open cholecystectomy and results in a smaller incision than a traditional open cholecystectomy. METHODS: We analyzed outcomes following laparoscopic and minilaparotomy cholecystectomy. 74 patients with gallstones were included. 45 patients were treated by a laparoscopic cholecystectomy and 29 patients were treated by a minilaparotomy cholecystectomy. RESULTS: Compared to the minilaparotomy cholecystectomy, the laparoscopic cholecystectomy resulted in a shorter mean hospital stay, a faster mean time to diet, and a longer mean operating time. During the first postoperative 24 hours more analgesics were used in the minilaparotomy cholecystectomy than in the laparoscopic cholecystectomy, and the laparoscopic cholecystectomy was more expensive than the minilaparotomy cholecystectomy. Postoperative complications occurred in 3 patients receiving a lapaaroscopic cholecystectomy and 1 patient receiving a minilaparotomy cholecystectomy. Conversion from a laparoscopic cholecystectomy to a traditional open cholecystectomy was necessary in 2 patients; no conversion to a traditional cholecystectomy was necessary in the minilaparotomy cholecystectomy. CONCLUSIONS: This study has proven the advantages of a laparoscopic cholecystectomy to be shorter hospitalization, less pain, and better cosmetic effect. Also, a minilaparotomy cholecystectomy has the advantages of a laparoscopic cholecystectomy and can be performed more safely.
Analgesics ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Diet ; Gallbladder ; Gallstones ; Hospitalization ; Humans ; Laparotomy* ; Length of Stay ; Postoperative Complications

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) has become a popular procedure for treating chronic sinusitis. Despite recent developments in medical and surgical techniques, primary ESS can still fail. Although revision ESS is one solution to the problem of recurrent sinusitis, revision surgery is stressful for patients and otolaryngologists. Therefore, we examined the causes of ESS failure and sought to find ways to prevent the failure of primary ESS. MATERIALS AND METHODS: All patients who underwent revision ESS in our department between April 2003 and March 2012 were studied retrospectively. RESULTS: During this period, revision ESS was performed 40 times to treat chronic sinusitis. We analyzed the preoperative computed tomographic (CT) findings of primary and revision ESS cases using the Lund-Mackay and Kennedy CT staging scores to compare disease severity. In our cases, the failure of ESS was not affected by the extent of disease, asthma, or allergy. Polyposis was the only useful predictor of revision ESS. CONCLUSION: Polyposis is an important predictor of revision ESS. We recommend that patients be followed frequently and carefully, especially those with polyps.
Asthma ; Humans ; Hypersensitivity ; Nasal Polyps ; Polyps ; Retrospective Studies ; Sinusitis

BACKGROUND AND OBJECTIVES: Olfaction is a critical function of our body that allows one to avoid potential dangers in daily living. Although there are numerous subjective and objective tests evaluating the olfactory function, there exist no studies assessing correlations among such tests for various causes of olfactory dysfunction, especially in Korea. SUBJECTS AND METHOD: We collected the olfactory functional test results of 473 subjects who visited our outpatient clinic. We categorized these patients into 5 groups: head trauma, post-upper respiratory infection, chronic sinonasal disease, toxic exposure, and idiopathic. All patients were examined using the Butanol Threshold Test (BTT) and Cross Cultural Smell Identification Test (CC-SIT). The patients' subjective symptoms were recorded using the Visual Analog Scale (VAS). RESULTS: The three tests showed significant correlations in different pairs (CC-SIT and BTT; r=0.512, p<0.001, BTT and VAS; r=0.558, p<0.001 and VAS & CC-SIT; r=0.567, p<0.001). Correlation results were lower in patients with olfactory disorders caused by an upper respiratory infection and head trauma than in those with olfactory disorders caused by sinonasal diseases. CONCLUSION: The results from all three tests showed significant correlations with one another. CC-SIT and VAS score seem to represent the olfactory loss caused by sensorineural dysfunction better than BTT.
Ambulatory Care Facilities ; Craniocerebral Trauma ; Humans ; Olfaction Disorders ; Smell