We experienced four patients that had gone unreduced for at least eight weeks and evaluated the results of the operative treatment in these paitents. All four cases were anterior dislocation, and among them three cases were dislocated by direct trauma and one was dislocated during seizure attack. Pain was moderate in one case and mild in three cases. In the preoperative range of motion, the average passive tlexion at the scapular plane was 143 degrees (90 degrees - l70 degrees) and average external rotation at the side was 33 degrees(5 degrees-60 degrees), but the average active flexion was 103 degrees, active external rotation was 16 degrees and the internal rotation at the back was the sacral level except one. All four patients complained of severe limitation of daily living activity due to limitation of motion and weakness and could not occupy their jobs. In all four cases, three dimensional CT scan was performed to evaluate glenoid and humeral bone defect and for preoperative planning. Operation was performed at 8 weeks after initial dislocation in two cases, 1 year later in one case and 2 years later in one case. Open reduction was done and the defect of humeral head was filled with osteochondral allograft in two cases. Fractured humeral head fragment was reduced and fixated with non-ahsorhahle suture in one case and prosthetic head replacement was performed in the other. As a result, three patients had a mild or moderate pain postoperatively and moderate functional restrictions in the activities of daily living, and they were considered to be unsatifactory. Two cases were subluxated during the follow-up. These results show that the overall prognosis for the surgical treatment of the chronic unreduced dislocated shoulder is unpredictable and unacceptable.
Activities of Daily Living ; Allografts ; Dislocations* ; Follow-Up Studies ; Head ; Humans ; Humeral Head ; Prognosis ; Range of Motion, Articular ; Seizures ; Shoulder* ; Sutures ; Tomography, X-Ray Computed

Supracondylar fractures of the femur following total knee arthroplasty are rare complication with reported rates ranging from 0.3% to 2.5%. Union of the fracture in proper alignment, without disruption of prosthetic component fixation and with maintenance of 90 of knee motion, is impotant in treatment of this type of fracture. Modalties of treatment are conservative or operative methods and operative treatment are open reduction 4 internal fixation, intramedullary nailing, revision arthroplasty using a prosthesis with a long stem and closed reduction and external fixation, but there are controversies in the method of treatment. Between Apr. 1989 and Jul. 1994, 10 patients were treated for supracondylar fracture of the ipsilaterai femur following total knee atthroplasty and 2 cases of them had arthrop]asty at other hospital. Average age of patients was 53 years (29-68 years), nine patients were women and one was man. The preoperative diagnosis was rheumatoid arthritis in four, degenerative osteoaithritis in three, posttraumatic osteoarthritis in one and tuberculosis sequelae of the knee in two. In nine cases mechanism of injury were slip down and in one was fall down. The interval hetween arthroplasty and fracture was an average of 22 months (9-79months). Two cases we.re treated with closed reduction and cast immobilization, one case was treated with open eduction and in1ernal fixation and seven patients of' ten cases were treated with closed intramedullay Ender nailing. The average foIlow-up period after fracture was 25 months (3 - 74months). We evaluated the results as the range of motion, bony union at simple radiograph and Knee Rating Score of Hospital for Special Surgery at last follow up. Eight cases of supracondylar fracture occuned among 350 patients, 514 cases of total knee arthroplasty which were operated at Kyung Hee Univcrsity Hospital between Apr. 1989 and Jul. 1994 and incidence was 1.6%. At the last follow up, all 10 cases achieved bony union and 7 cases using Ender naiIing achieved clinical bony union which enabled patients to do weight-bearing without pain at postoperative 6-8 weeks and radiological union was achieved at postoperative 12 weeks. Range of motion were average 105 degrees (80 J.20 degrees) hefore fracture and 86 degrees (6S 120 degrees) at the last follow up and HSS Knee rating score were average 80.3 points (59 94 points) before fracture and average 78.8 points (66-89 points) at the last follow up. At 7 cases using Ender nailing, range of motion were average 106 degrees (90 11S degrees) hefore fracture and 91 degrees (6S-105 degrees) at last follow up and HSS Knee rating score were average 80.6 points (59-94 points) before fracture and average 80.3 points (72-89 poiints) at the last follow up. Closed iintramedullary Ender nailing is a gecommendable operative method in the treatment of supracondylar fracture following total knee arthroplasty considering to good bony union, satisfactory functional result, easy operative technique and less postoperative complication.
Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Female ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Incidence ; Knee* ; Osteoarthritis ; Postoperative Complications ; Prostheses and Implants ; Range of Motion, Articular ; Tuberculosis ; Weight-Bearing

BACKGROUND: Self-expandable metallic stent is an effective method in palliative treatment of malignant biliary stricture. However, it is controvesial in benign biliary stricture due to recurrent jaundice, cholangtitis, and finally, obstruction of stent. The purpose of this study was to determine the long-term effectiveness of Gianturco expandable metallic stents in benign biliary strictures. METHODS: We inserted Gianturco self-expandable metallic stent in 13 patients (42~69 years old, 6 men and 7 women) with benign biliary stricture between November 1991 and September 1994 in Wonkwang University Hospital. All patients had a previous history of biliary surgery and underwent balloon dilatation procedure for management of strictures. Insertion routes were percutaneous transhepatic biliary drainage tracks in 8 cases and T-tube tracks in 5 cases. The insertion site was the right intrahepatic duct in 5 cases, the left intrahepatic duct in 2 cases, both intrahepatic ducts in 1 case, common hepatic duct in 1 case, and distal common bile ducts in 4 cases. The stents used were 2~6cm in length and 8~12mm in diameter. The follow-up period was 46months to 81months(mean, 67months). RESULTS: The initial technical success rate was 100% with good immediate patency in all patients. Nine patients(69.2%) had no recurrence of the initial strictures during the follow-up period and 4 patients(30.7%) had further symptoms of biliary obstruction caused by recurrent cholangitis or intrahepatic duct stone formation. These 4 recurrent biliary strictures were treated by surgical methods. The recurrent stricture sites were distal common bile duct(1case), left intrahepatic duct(1case), both intrahepatic ducts(1case), and Roux-en-Y hepaticojejunostomy site(1case). CONCLUSIONS: According to the results of long-term follow-up, expandable metallic stent is a useful method in recurrent biliary strictures, especially in the case where operation is not feasible; poor risk patients, patients refusing operation, multiple biliary operation.
Bile ; Cholangitis ; Common Bile Duct ; Constriction, Pathologic* ; Dilatation ; Drainage ; Follow-Up Studies* ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Palliative Care ; Recurrence ; Stents*

Subarachnoid hemorrhage (SAH) induces an inflammatory reaction and may lead to ischemic brain damage. The pathogenesis of brain dysfunction and delayed ischemic symptoms remain difficult to understand despite extensive surveys of such reactions. Cytokine production in the central nervous system following SAH and its relation with clinical outcome have hardly been studied. This study was aimed to determine whether the levels of IL-1 beta, IL-6 and TNF-alpha in the initial cerebrospinal fluid would increase following aneurysmal SAH, and be related with development of delayed ischemic deficit and clinical outcome. Nineteen patients suffering from aneurysmal SAH and 12 control volunteers were the subjects in this study. Cerebrospinal fluid samples were obtained on admission and the levels of each cytokine were determined with enzyme-linked immunosorbent assay. Patients with aneurysmal subarachnoid hemorrhage showed elevated levels of IL-1 beta, and TNF-alpha on admission. The patients with poor neurological status showed high levels of IL-1 beta, and IL-6. The patients who developed delayed ischemic deficit had high level of IL-6. We suggest that elevated level of IL-6 in cerebrospinal fluid of patients with aneurysmal SAH on admission can predict the high risk of delayed ischemic deficit.
Adult ; Aged ; Brain Ischemia/*cerebrospinal fluid/*diagnosis/immunology ; Cytokines/*cerebrospinal fluid ; Female ; Glasgow Outcome Scale ; Human ; Interleukin-1/cerebrospinal fluid ; Interleukin-6/cerebrospinal fluid ; Male ; Middle Age ; Predictive Value of Tests ; Subarachnoid Hemorrhage/*cerebrospinal fluid/*diagnosis/immunology ; Tumor Necrosis Factor/cerebrospinal fluid

BACKGROUND: It has been well known that absolute and interpeak latencies of brainstem auditory evoked potentials (BAEP) are usually prolonged in diabetics. However, Its etiology is still controversial. We tried to identify whether the cause is structural or metabolic in origin by performing BAEP and brain MRI in the diabetic patients. METHODS: BAEP were performed in both the diabetic patients (DM) group (16 males and 15 females) and the normal control group (25 males and 33 female). A brain MRI was performed in the DM group on those who showed abnormal BAEP and com-pared the results of BAEP of the DM group with those of the control group. RESULTS: 7 patients (22.6%) showed abnor-mal BAEP (male; 6, female; 1, unilateral; 4, bilateral; 3) when abnormal BAEP was defined as being larger than two and a half standard deviations of the control group BAEP results. Two males of the DM group who showed abnormal structural lesions of the pons in their brain MRI were not included in the statistical analysis. The remaining 14 diabetic male patients (mean age: 58.7 +/-9.1 years, mean disease duration: 6.1 +/-4.7 years, mean hemoglobin (Hb) A1C: 7.7 +/- 2.0%) and 15 diabetic female patients (mean age: 60.6 +/-10.8 years, mean disease duration: 5.4 +/-5.1 years, mean HgA1C: 7.8 +/-2.1%) were stastistically analyzed. Interpeak latencies of I-III, III-V, and I-V were found to be signifi-cantly prolonged in the DM group. The prolongation of interpeak latencies of I-III and I-V were found to be signifi-cantly correlated with the disease duration only in the diabetic female patients, but not with age and HbA1c. CONCLUSIONS: These findings suggest that both metabolic derangement and structural lesion contribute to prolonging the central conduction time on BAEP pathway in diabetics.
Brain ; Brain Stem* ; Diabetes Mellitus ; Evoked Potentials, Auditory, Brain Stem* ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Pons

Auditory agnoia is defined as a disability to recognize spoken languages and/or nonverbal environmental sounds and music despite adequate hearing while spontaneous speech, reading and writing are preserved. Usually, either bilateral or unilateral temporal lobe especially transverse gyral lesions are responsible for auditory agnosia. Subcortical lesions without cortical damage else rarely causes auditory agnosia. We pesent a 65-year-old right-handed male with generalized auditory agnosia caused by bilateral subcorcal lesions. After the two attacks of stroke, he could not understand and recognize spoken words and meet of non verbal sounds. Repetition and dictation were impossible but spontaneous speech was fluent and comprehensible even though mild paraphasic error was noted. Naming was normal. He could understand and read aloud the written words and phrases. Clinical examination of the ears was normal as were audiometry and brainstem auditory evoked potential. Brain magnetic resonance images showed a large cavitary lesion due to an old intracerebral hematoma in right subcortical temporoparietal lobe with preserved superior temporal gyrus and a slit like subcortical lesion in the left insula.
Aged ; Agnosia* ; Audiometry ; Brain ; Ear ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Hematoma ; Humans ; Male ; Music ; Stroke ; Temporal Lobe ; Writing

A new method of urinary diversion via Skinner`s modification of Koch continent ileal reservoir was tried. With this method continence with storage of urine under low pressure is well maintained so that no external applicances are necessary. Ileorenal reflux is also prevented with this nipple forming technique. From May l986 to September l986, 4 patients underwent urinary diversion that included creation of a modified Koch pouch by Skinner. Previous urinary diversion was by ureterocutaneous diversion in 1 patient. A total of 3 patients underwent radical cystectomies for bladder cancer In 1 patient, simultaneous urethrectomy was done because of carcinoma in situ in the urethra. There were no operative mortalities. All patients are continent and without reflux to the upper urinary tract. The volume capacity of pouch is more than 400ml. The pouch is emptied by self-catheterization every 4 to 6 hours during the day and once at night. Postoperative follow-up presently is short and it is impossible to check late complications. Although preliminary, this clinical trial suggests that the quality of life for patients can be improved markedly by the modified Koch continent ileal reservoir.
Carcinoma in Situ ; Colonic Pouches* ; Cystectomy ; Follow-Up Studies ; Humans ; Mortality ; Nipples ; Quality of Life ; Urethra ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urinary Tract

Epidermoid cysts occur rarely on the palms and soles, where hair is not present. These cysts have long been assumed to arise from traumatic implantation of epidermal fragment, but the pathogenesis is still controversial. Recently, with microscopic findings, immunohistochemical features, and molecular studies, the epidermoid cysts of the sole may be induced by the human papillomavirus. We report two cases of epidermoid cysts of the sole with the discussion of the pathogenesis.
Epidermal Cyst* ; Hair ; Humans*

The purpose of this study is to evaluate the morphologic findings of the labrum and capsuloligamentous structures in the normal and unstable shoulders and to compare the effectiveness of double contrast arthrographic findings which were taken with supine and prone position. We reviewed the computerized tomographic arthrogram in 9 cases of normal shoulder and l3 cases of shoulder instability. We evaluated the shape of the labrum, the attachment of anterior capsule and the amount of capsular laxity. Capsular laxity was compared each others in normal, the unidirectional instability and the multidirectional instability. Among these materials, we simultaneously performed CT arthrogram with supine and prone position and evaluated which is more reliable and accurate. Scapular inclination was ahout 25 degrees in the supine position and ahout 60 degrees in the prone position. Normal glenoid labrum varied in size and shape, so its lack of a classic appearance might not indicate a labral tear. Variations existed in the anterior capsular attachment onto the glenoid. The anterior capsule was used to attach far away from the glenoid rim. but it might not indicate an anterior instability. With the prone position, the labral lesion took more excellent visualization due to the contrast coating on the glenoid labrum in both anterior and posterior. Anterior capsular expansion was seen well with prone position in anterior instability. In summary, for proper interpretation of the instability, awareness of the morphologic variations of the labrum and capsuloligamentous structure is important. CT double contrast arthrography with prone position has made a significant contribution to improving and easing the documentation of variety of anatomic abnormalities. Now we recommend the prone position in CT arthrogram for imaging glenoid labrum pathology in shoulder instability.
Arthrography ; Pathology ; Prone Position ; Shoulder* ; Supine Position

Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract ; Papilloma* ; Prognosis