BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle* ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.
Aged ; Congenital Abnormalities ; Exercise ; Female ; Humans ; Incidence ; Infant ; Male ; Mothers ; Neck ; Physical Therapists ; Torticollis ; Uterus

PURPOSE: This study was conducted to compare the PET and CT findings for patients with a pulmonary lymphangitic metastasis. MATERIALS AND METHODS: We retrospectively reviewed the PET and CT findings of seven patients diagnosed with a pulmonary lymphangitic metastasis between May 2005 and May 2007. RESULTS: All patients had interstitial thickening, as seen on a CT scan, while the PET scans showed abnormal findings in only three patients. In these three patients, one patient had interlobular septal thickening of more than 10, another patient had interlobular septal thickening of more than 5 but less than 10, and another patient had interlobular septal thickening of less than 5. All of the patients had bronchovascular bundle thickening. However, among the four patients that had normal FDG uptake, no patient had interlobular septal thickening of more than 10, two of the patients had interlobular septal thickening of more than 5 but less than 10, and the remaining patients had interlobular septal thickening of less than 5. Only two of the patients had bronchovascular bundle thickening. CONCLUSION: All patients with pulmonary lymphangitic metastasis have typical CT findings, but some of the patients had FDG uptake, as seen in the PET scans. Thus, CT is a more useful modality for diagnosis for pulmonary lymphangitic metastases.
Diagnosis ; Humans ; Lung Neoplasms ; Lymphatic Metastasis ; Neoplasm Metastasis* ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To assess the high-resolution CT and pathologic findings of fat embolism experimentally induced in rabbit lung. MATERIALS AND METHODS: Twelve rabbits were divided into four groups, namely control, 2-hour, 24-hour, and 72-hour, with three rabbits in each, and closed tibiofibular fractures were induced. After the rabbits were sacrificed, high-resolution CT scanning of the artificially inflated lungs was performed, and the CT findings were analyzed by two radiologists. They determined the presence or absence of ground glass opacity or consolidation, the extent of the lesions (using a 10% grading scale), and their distribution, reaching a consensus. The pathologic findings were analyzed using the specimens prepared by H & E and Oil-red O staining. RESULTS: Although the high-resolution CT findings of pulmonary fat embolism were nonspecific, bilateral patchy ground glass opacity (100%), and focal air-space consolidation surrounding the bronchovascular bundle (89%) were most common. In all groups, the occlusion of vessels by fat globules was confirmed by Oil-red Ostaining. The microscopic findings included focal pulmonary hemorrhage, edema, alveolar collapse, and extensive infiltration of inflammatory cells in the lung parenchyma. The 24-hour group showed more extensive change in high-resolution CT and pathologic findings than did the others. CONCLUSION: Fat embolism in rabbit lung may occur after closed tibio-fibular fracture. The extent of the lesion revealed by high-resolution CT correlated closely with the pathologic findings. High-resolution CT may thus be helpful for the detection of pulmonary fat embolism and evaluation of its extent.
Consensus ; Edema ; Embolism, Fat* ; Glass ; Hemorrhage ; Lung* ; Pulmonary Embolism ; Rabbits ; Tomography, X-Ray Computed

PURPOSE: To determine whether the compression technique is a valuable additional method for differentiating between benign and malignant breast masses. MATERIALS AND METHODS: The ultrasonographic findings of 95 benign and 53 malignant masses, all pathologically proven, were prospectively analyzed with regard to five diagnostic criteria: shape (regular/irregular), retrotumoral acoustic phenomena (posterior enhancement/posterior attenuation), internal echo pattern (homogeneous/inhomogeneous), compression effect on shape (distortion/no change), and compression effect on internal echo pattern (more homogeneous/no change). RESULTS: The number of cases of benign and malignant masses, respectively, was as follows: regular / irregular shape: 84/11, 9/44; posterior acoustic enhancement/posterior attenuation: 82/13, 16/37; homogeneous/inhomogeneous internal echo pattern: 78/17, 14/39; distortion/no change in shpae: 76/19, 5/48; and more homogeneous/ no change in internal echo pattern: 71/24, 3/50. For all diagnostic criteria for the differentiation of benign and malignant masses, the differences were statistically significant (p<.05). CONCLUSION: Ultrasonography is helpful for differentiating between benign and malignant breast masses. The compression technique is a valuable additional diagnostic method.
Acoustics ; Breast* ; Prospective Studies ; Ultrasonography*

Between January 1980 and December 1989. 76 cases of renal cell carcinoma were treated by radical nephrectomy at Department of Urology. Hanyang University Hospital. Among them 65 cases were followed up at least 12 months and 16 cases (24.6%) were diagnosed incidentally. The ratio or incidentally detected renal cell carcinoma has been increasing steadily in the past decade. Two of 24 patients (8%) were discovered incidentally between 1980 and 1984 compared with 14 of 41(34%) between 1985 and 1989. Eleven of these cases(68.7%) were detected by ultrasound. three by computerized tomography. and two by excretory urography. Nine of these cases were unexpectedly found by chance during examination for health check up. while others were found during examination for other diseases. The stage and grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma. respectively (p<0.01. p<0.05). Primary tumor size was also significantly smaller in the incidental carcinoma(p<0.05). The S-year survival rates for the incidental and symptomatic carcinomas after radical nephrectomy were 93.7% and 53.6%. respectively (p<0.001). These data have shown an increase in the proportion of incidentally diagnosed cases. Ultrasonography is a useful tool to detect low stage asymptomatic renal cell carcinoma and has led to earlier diagnosis, lower stage and possible longer survival in patients with incidentally discovered renal cell carcinomas compared with patients where the diagnosis was suspected. These results supported the rationale for the efforts to detect renal cell carcinoma at health check-up or the attention to renal lesions on examination for unrelated diseases.
Carcinoma, Renal Cell* ; Diagnosis ; Humans ; Nephrectomy ; Survival Rate ; Ultrasonography ; Urography ; Urology

Three hundred sixty-two(male 131, female 231) elderly aged over 65 in Chungbuk area were interviewed to determine the disease states and drug usage patterns. The prebalence of disease was 78% and women reported more chronic diseases(83%) than men(71%). Elderly who live with spouse and have an occupation have a lower rate of disease. Average number of diseases of the elderly was 1.8+/-1.1, and women(2.1+/-1.3) have significantly higher average number of diseases than that of men(1.4+/-0.7). Also the elderly in urban areas(2.1+/-1.4) have significantly higher number of diseases than that of the elderly in rural areas(1.6+/-0.9). Arthritis, hypertension, cardiovascular and gastric diseases were the most frequently listed chronic diseases in order for both men and women. Anemia and fracture of bone were relatively higher in women than in men. Particularly, the arthritis of the urban elderly have a rate of 1.5 times higher than that of the rural elderly. Fifty-two percent of the elderly were currently using drugs ; among drug users 71.2% used prescription drugs and 20.5% used nonprescription drugs. The average number taken per person was 2.1+/-1.4 and there was no sex or age difference. However, the elderly in rural areas (2.7+/-1.7) consumed a significantly higher number of drugs than those in urban areas(1.7+/-0.7). The average number of prescription drugs taken was 2.0+/-1.4 while the average of nonprescription drugs taken was 1.3+/-0.6. Analgesics and antihypertensive drugs were most commonly used. Vitamin and analgesics were the most frequently used self-prescribed drugs. It was noted that potential adverse drug interaction by concominant drug consumption for arthritis and antihypensive drug, abuse of digestants and antiacid without treatment of the underlying disease, and misuse of quick-acting bowel medications were problematic for the elderly. In addition drugs used for the elderly have some adverse effect on the digestive system. The types and composition of drugs used by the elderly were identified and presented. Medication compliance was poor and 13.5% reported adverse reactions such as edema, heartburn, nausea, and difficulty with eating. Seventeen percent of the elderly obtained drugs arranged by those other than medical staff. Also, even among those elderly who obtained drugs prescribed by a doctor, 69.1% of subjects had not receive instruction about potential adverse reactions. These results suggest that nutritional problems related to drug usage might exist and so dietitians, either individually or as members of health teams, need to have a better understanding of drug-nutrient interaction and closer supervision, and drug information/education service should therefore be provided to prevent or minimize adverse drug reaction in elderly users of medication.
Aged* ; Analgesics ; Anemia ; Antihypertensive Agents ; Arthritis ; Chronic Disease ; Chungcheongbuk-do ; Digestive System ; Drug Interactions ; Drug Users ; Drug-Related Side Effects and Adverse Reactions ; Eating ; Edema ; Female ; Gastrointestinal Agents ; Heartburn ; Humans ; Hypertension ; Male ; Medical Staff ; Medication Adherence ; Nausea ; Nonprescription Drugs ; Nutritional Status* ; Nutritionists ; Occupations ; Organization and Administration ; Prescription Drugs ; Spouses ; Stomach Diseases ; Vitamins

Polyarteritis nodosa, one of the necrotizing vasculitis involving predominantly small and medium sized arteries is a rare disease. Gastrointestinal involvements have been reported in more than 50% of patients at some time during its course. The small bowel is the frequent site of involvement in clinically apparent ischemic disease. The colon is less commonly involved, particularly at the initial presentation. We report a rare case of polyarteritis nodosa with ischemic colitis, perforation, and pseudomembrane formation.
Arteries ; Colitis, Ischemic ; Colon ; Enterocolitis, Pseudomembranous* ; Humans ; Polyarteritis Nodosa* ; Rare Diseases ; Vasculitis

Percutaneous vertebroplasty is an effective, minimally invasive procedure for the treatment of vertebral compression fractures, and is a technique for treating lower back pain that appears to be increasingly popular throughout the world. We experienced two cases involving a rare complication of percutaneous vertebroplasty, namely pulmonary embolism caused by acrylic cement. One patient showed no subjective symptoms after vertebroplasty, while the other experienced chest pain. In the former, fluoroscopy demonstrated perivertebral venous leakage during vertebroplasty, and at chest radiography, tubular or branching high-density linear structures were observed. In addition, intravascular emboli were identified at CT. In the second patient, symptomatic therapy led to reduced chest pain.
Chest Pain ; Fluoroscopy ; Fractures, Compression ; Humans ; Low Back Pain ; Pulmonary Embolism* ; Radiography ; Thorax ; Vertebroplasty*

The long QT syndromes have been classified into acquired or inheritary forms, both of which are associated with a characteristic type of life-threatening polymorphic ventricular tachycardia called torsade de points. Beta-adrenergic blocker is the first cholic treatment, but in those whom cardiac events are not prevented by beta - blockade, left thoracic sympathetic ganglionectomy may be useful in selected cases. A 50-year-old woman had an recurrent syncopal attack in which she was unconscious for 1-2 min and 1-2 times a month for 10 years. The EKG revealed that QT & QTc intervals were 744 and 632 msec respectively. Treatment with Beta-adrenergic blocker and calcium channel blocker was ineffective in preventing recurrence of syncopal spell. Therefore, she underwent left thoracic sympathetic ganglionectomy with thoracoscope. During the 9 months after operation, she was free of syncopal episodes and is doing well.
Calcium Channels ; Electrocardiography ; Female ; Ganglionectomy* ; Humans ; Long QT Syndrome* ; Middle Aged ; Recurrence ; Syncope ; Tachycardia, Ventricular ; Thoracoscopes*