The incidence of tibial fracture is increasing due to increasing tendency of traffic and industrial accidents. In general, the tibial fracture is treated with closed method but it is difficult because of its anatomical cbaracteristics. We have been treated tibial fractures with total contact short leg cast which supports the 7 points such as tibial condyle, tuberosity, margo anterior, medial malleolus, fibular head, lateral malleolus and heel rigidly and molding it as trangiular shape like the tibia using both palms and fingers The advantages of this cast sre to prevent rotation, to promote osteogenesis with early weight bearing and to prevent ankylosis of knee joint. In fact, the sverage healing time was 14weeks Rotation, nonunion, angulation ove cast sore, nerve injury were not noticed and the shortening was 4. 1mm in closed fractures, 5. 3mm in open fractures.
Accidents, Occupational ; Ankylosis ; Fingers ; Fractures, Closed ; Fractures, Open ; Fungi ; Head ; Heel ; Incidence ; Knee Joint ; Leg ; Methods ; Osteogenesis ; Tibia ; Tibial Fractures ; Weight-Bearing

A 61-year-old female had neurofibromas situated on the right side of upper trunk, shoulder and neck in the distribution of dermatomes C3 and C4(right), which developed 3 years ago. There were not cafe-au-lait spots, axillary frecklings, or Lisch nodule (iris pignented hamartoma). Biopsy specimen showed collagenous wavy fibrils among which spindle-shaped and round cells were embedded as seen in the typical neurofibroma. This case was considered to be a segmental form of von Recklinghausen's disease.
Biopsy ; Cafe-au-Lait Spots ; Collagen ; Female ; Humans ; Middle Aged ; Neck ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1 ; Shoulder

Computerized tomography has been used in the evaluation of the intracranial lesions. Recently the usage of computerized tomography has progressively widened in many fields of clinical practice. In orthopedics computerized tomography has been tried in the diagnosis and the determination of treatment of tumors, spinal disorders, hip disorders and knee problem. Four problem cases in which concentric reduction could not be obtained after closed reduction of hip dislocations were evaluated by computerized tomography from Apr, 1, 1983 to Mar. 31, 1984 in the Capital Armed Forces General Hospital and following conclusiions were obtained: 1. Open reduction revealed that muscles(adductor and pyriformis muscles), joint capsule and osteocartilaginous loose bodies (femoral and acetabular) were interposed to hinder concentric reduction. Large posterior acetabular fragment induced instability and redislocation of the hip. 2. When there were 2-3 mm lack of symmetry of the two femoral heads or any abnormal findings(breakage of Shenton's line etc.) in plain roentgenography, computerized tomography was recommanded, and muscles, osteocartilaginous loose bodies and instability were found. 3. Computerized tomography is an easy simple method and has a great diagnostic value in the evaluation of asymmetry and instability after closed reduction of traumatic hip dislocations.
Acetabulum ; Arm ; Diagnosis ; Head ; Hip Dislocation ; Hip ; Hospitals, General ; Joint Capsule ; Knee ; Methods ; Muscles ; Orthopedics ; Radiography

No abstract available.
Cyclotrons*

Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, requiring permanent cardiac pacing in end-stage renal disease hemodialysed patients are very few. Most cases of sick sinus syndrome are idiopathic, and the cause can be multifac- torial. A-V conducton defects were attributed to extensive metastatic calcifications, involving the cardiac skeleton, conservative to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or non uremic patients and pacemaker implantation should be instituted. We report a case of sick sinus syndrome derived in elderly patient on hemodialysis.
Aged* ; Calcitriol ; Calcium Carbonate ; Death, Sudden, Cardiac ; Humans ; Hyperparathyroidism ; Kidney Failure, Chronic ; Mortality ; Renal Dialysis* ; Sick Sinus Syndrome* ; Skeleton ; Uremia

No abstract available.
Aorta, Thoracic*

BACKGROUND: Differential diagnosis of lichen sclerosus et atrophicus( SA) and scleroderma is occasionally difficult. OBJECTIVE: The purpose of this study was to attempt differentiation between the two diseases using imrnunohistochemical stain and lectins. MEHTODS: Paraffin-embeddred sections of 4 cases of LSA and 11 cases of scleroderma were evaluated for this study. Using lectins, such as peanut agglutinin(PNA), siybean agglutinin(SBA), Ulex europaeus agglutinin-I(UEA-I) and Dolichos biflorus agglutinin(DBA) and the avidin-biotin-peroxi-dase complex(ABC) technique, differential lectin binding patterns betv een the two diseases were examined. RESULTS: In the case of LSA, PNA and SBA stained the upper and lower spinous layer of the epidermis, and UEA I also stained the spinous layer of the epidermis weakly, but no DBA was stained. In the case of scleroderma, PNA stained not only the spinous layer but also the basal layer, SBA stained the upper half of the spinous layer but not the lower half of the pinous layer of epidermis. But UEA-I stained the vascular endothelial cells of dermis instead of epidermis, and DBA stained only the basal layer of epidermis. CONCLUSION: Staining of these 4 lectins on paraffin-embedded sectians using ABC teehnique could be helpful in differenting LSA and scleroderma.
Dermis ; Diagnosis, Differential ; Dolichos ; Endothelial Cells ; Epidermis ; Lectins* ; Lichen Sclerosus et Atrophicus* ; Lichens* ; Ulex

A 6-year-old boy presented in December 1986 with a 1-year history of a nonpruritic flesh-colored papular eruption that began on the dorsum of left hand and gradually appeared on other areas, such as upper and lower extremities, trunk and external genitalia. Complete blood cell count. urinalysis, VDRL, stool examination, liver function test and chest X-ray were negative or within normal limits. On physical examination, he had uniform, pinhead-sized, flat-topped, shiny, discrete paples on the whole body surface. No oral lesions were found. Histopathologically skin biopsy specimen showed a circumscribed nest of infiltrate consisted of lymphocvtes, histiocytes and a few epitheloid cells. The cell nest was separated from the overlying flattened epidermis by a large space. Direct immunofluorescent test was negative. He had been treated with systemic corticosteroid for two months without recurrence until nowadays.
Biopsy ; Blood Cell Count ; Child ; Epidermis ; Genitalia ; Hand ; Histiocytes ; Humans ; Lichen Nitidus* ; Lichens* ; Liver Function Tests ; Lower Extremity ; Male ; Physical Examination ; Recurrence ; Skin ; Thorax ; Urinalysis

Cutaneous mycobacterial infection can occur with Mycobacterium tube culosis or other mycobacterial agents. The commonest of the group IV rapidly growing mycobacteia Mycobacterium fortuitum, has widespread distribution in natur, and is an uncommon causative agent of human mycobacterial infection. We report herein a case of Mycobacterium fortuitum infection follcwiiig an antibiotics susceptibility test. This 24-year-old man suffered fram ulcerative itchy nodules on the left forearm where the antibiotics susceptibility test was don. The skin biopsy specimen revealedly. iphohistiocytic granulomatous infiltration in the dermis. Culture of the tissue specimen revealed rapicly growing yellowish colonies, which was isolated to Mycobacoterium fortuitum. Among 3 biovariants of M. fortuitum, our case was revealed to he biovariant fortuiiam: Surgical excision was performed followed by the administration of antiliiiitics, and no sign of relapse was noted until now, 1 year since.
Anti-Bacterial Agents* ; Biopsy ; Dermis ; Forearm ; Humans ; Mycobacterium fortuitum* ; Mycobacterium* ; Recurrence ; Skin ; Ulcer ; Young Adult

PURPOSE: The purpose of this study was to evaluate and compare the scintigraphic findings and diagnostic accuracy of double-phase Tc-99m sestamibi scan in primary and secondary hyperparathyroidism (HPT). MATERIALS AND METHODS: We retrospectively reviewed 16 cases of primary (18 lesions) and 11 cases of secondary HPT (44 lesions) who underwent Tc-99m-sestamibi scan before the surgical intervention. Scan was performed using LEM camera (Siemens, Germany) after the injection of 740MBq of Tc-99m sestamibi. Routine image consisted of baseline and 3-hour delayed images and each image was obtained using both parallel and pine hole collimator. The study population was 27 patients (male/female=5/22, age: 49.1+/-10.8). RESULTS: Eighteen lesions of primary HPT consisted of 13 adenomas and 5 hyperplasias, while all lesions of secondary HPT were hyperplasias. Among the case of primary HPT, we could detect all the lesions of 13 adenomas but only 2 lesions of 5 hyperplasias (40%) could be detected by double phase scintigraphy. Three cases of primary lesion showed decreased uptake in delayed images compared with baseline. The sensitivity, specificity, positive predictive value and accuracy of primary and secondary HPT were 58.8% (10/17), 83.3% (10/12), 83.3% (10/12), 75.9% (22/29), and 37.5% (15/40), 50% (2/4), 88.2% (15/17), 38.6% (17/44), respectively. Overall sensitivity, specificity, positive predictive value and accuracy were 43.9% (25/57), 75% (12/16), 86.2% (25/29), and 53.4% (39/73). There were no statistical difference between the weight of primary and secondary HPT lesion (p>0.05). CONCLUSION: Tc-99m sestamibi scan is fairly good modality to detect parathyroid lesion in patient with primary HPT before the surgical intervention. However, since some of cases may reveal decreased uptake in delayed image, a careful attention to the findings of baseline images may be helpful. Still the low accuracy of sestamibi scan in diagnosis of secondary HPT prohibits routine use of it for this disease.
Adenoma ; Diagnosis ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperplasia ; Parathyroid Glands ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity