We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.
Adult ; Aged ; Female ; Femoral Fractures/radiography/*surgery ; Fracture Fixation, Internal/*adverse effects/methods ; Hip Fractures/*etiology/radiography ; Humans ; Iatrogenic Disease ; Male ; Middle Aged

Pulmonary hyalinizing granuloma (PHG) is a rare disease that usually presents with multiple bilateral pulmonary nodules and characteristic histological findings, with hyalinized collagen lamellae. Because of the absence of characteristic radiologic and clinical features, PHG is usually diagnosed after surgical resection or biopsy. We performed thoracoscopic wedge resection for a pulmonary nodule located in the right lower lobe that proved to be PHG histopathologically. We report two cases along with a review of the literature.
Biopsy ; Collagen ; Granuloma ; Hyalin ; Rare Diseases

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.
Aged ; Bacteremia ; Drainage ; Empyema ; Escherichia ; Escherichia coli ; Female ; Humans ; Pyelonephritis

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.
Aged ; Bacteremia ; Drainage ; Empyema ; Escherichia ; Escherichia coli ; Female ; Humans ; Pyelonephritis

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.
Catheters ; Hemorrhage ; Lacerations ; Rupture ; Sutures ; Tendon Injuries ; Tendons

There have been an increasing number of reports of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas since its first report by Ohhasi et al. in 1982. Most IPMNs arise from Wirsung's duct or its branches, whereas IPMNs arising from Santorini's duct are rare. Pancreas divisum is a common congenital anatomical anomaly characterized by the lack of fusion of the ventral and dorsal parts of the pancreas during the eighth week of fetal development. Although clinical significance of pancreas divisum has been the subject of debate for many years, there seems to be little doubt that in certain patients there is a causal relation between pancreas divisum and pancreatitis. Also, it is occasionally accompanied by a pancreatic tumor. Herein, we report a case of IPMN arising from Santorini's duct in patient with complete type of pancreas divisum.
Adenocarcinoma, Mucinous/*diagnosis/etiology ; Aged ; Carcinoma, Pancreatic Ductal/*diagnosis/etiology ; Carcinoma, Papillary/*diagnosis/etiology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis, Differential ; Female ; Humans ; Pancreatic Ducts/abnormalities/*surgery ; Pancreatic Neoplasms/*diagnosis/etiology

PURPOSE: There are several modalities to reattach the amputated auricle. Although microvascular replantation can achieve the best outcome, it is technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. METHODS: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket(Fig. 1, Below, left). RESULTS: The ear was reepithelialized spontaneously in 7 days. In 3 months, the reattached ear shows satisfactory appearance without contour deformity(Fig. 1, Below, right). CONCLUSION: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.
Amputation, Traumatic ; Congenital Abnormalities ; Dermis ; Ear ; Ear Auricle ; Epidermis ; Oxygen ; Replantation ; Skin ; Sutures ; Transplants

BACKGROUND: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. MATERIAL AND METHOD: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. RESULT: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was 90+/-38.5 min. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chest-tube insertion was 11.9+/-5.8 (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. CONCLUSION: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.
Anti-Bacterial Agents ; Drainage ; Empyema ; Empyema, Pleural ; Follow-Up Studies ; Humans ; Pleural Effusion ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

Cardiac papillary fibroelastomas are the second most common primary tumor of the heart and they most commonly affect the left cardiac valves. However, occurrence of this tumor on the right side of the heart has been rarely reported, with only a few cases having been documented on the pulmonary valve. We present here a rare case of a papillary fibroelastoma that occurred on the pulmonary valve and this was successfully managed by replacing the pulmonary valve in a patient with congestive heart failure.
Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Neoplasms ; Heart Valves ; Humans ; Pulmonary Valve

We report a case of hepatocellular carcinoma (HCC) with pulmonary metastases treated with repeated hepatic arterial infusion chemotherapy (HAIC) comprising epirubicin and cisplatin, and systemic infusion of 5-fluorouracil (a modified EC/F protocol), which led to complete remission. A 49-year-old man with compensated liver cirrhosis experienced intrahepatic recurrence of HCC with extensive lung metastases. The modified EC/F therapeutic protocol, which was applied at the tenth cycle every 4-5 weeks, resulted in disappearance of the pulmonary metastases and normalization of serum alpha-fetoprotein levels. A single small HCC lesion was found in the left lobe of the liver 13 months after the final chemotherapy session. HAIC with the same regimen was conducted again, followed by percutaneous intratumoral chemoinjection therapy with 5-fluorouracil and interferon-gamma. Thereafter, there was no evidence of recurrence in either the liver or the lung, as evidenced by image analysis and expression of tumor markers. The disease-free intervals for the liver and lung were 41 and 54 months, respectively.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Cisplatin ; Epirubicin ; Fluorouracil ; Humans ; Interferon-gamma ; Liver ; Liver Cirrhosis ; Lung ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Biomarkers, Tumor