No abstract available.

The coexistence of the variants of porokeratosis is very rare. We report a case of coexistence of linear porokeratosis with disseminated superficial actinic porokeratosis (DSAP). A 43-year-old wornan first noticed a brownish papule on the left side of groin in early infancy. She developed multiple discrete or confluent keratotic plaques in linear fashion on the left lower extrernity and trunk in childhood. These leaions became pruritic in summer. Two years ago, she developed multiple scattered small annular lesions on the face and forearms. Her family history showed no abnormalities. Biopsy specimene from the groin and trunk showed eornoid lamella.
Adult ; Biopsy ; Forearm ; Groin ; Humans ; Porokeratosis*

The skin lesions of leprosy have a great similarity to various other lesions. Fasal has called it the great imitator. Sometimes these skin lesions can b misdiagnosed because the physician does not consider leprosy. We reported a case of early lepromatous leprosy in 42 year old male. His skin lesions were similar to secondary syphilid. There were no sensory changes on the skin lesions and no enlargement of the peripheral nerves. Numerous AFB(+) bacilli from the skin smear confirmed our diagnosis of leprosy.
Adult ; Diagnosis ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Male ; Peripheral Nerves ; Skin Manifestations* ; Skin* ; Syphilis, Cutaneous

No abstract available.
Ascorbic Acid* ; Child* ; Humans

PURPOSE: This study was to measure the angle between the femoral epicondylar axis and the femoral posterior condylar axis, to clarify which axis can be used as a guideline to achieve proper rotational align- ment of femoral component in total knee arthroplasty. MATERIAL AND METHODS: From Jan. 1997 to Dec. 1998, the axial images of MRI of 121 patients who sustained acute knee injury were selected to measure the posterior-epicondylar angle(the angle between the femoral epicondylar axis and the femoral posterior condylar axis). Congenital anomaly or any fracture cases were all excluded. Comparisons were made according to gender and ages and the student t-test was used to evaluate the statistical differences. RESULTS: The mean posterior-epicondylar angle was a 4.8(+- 2.0) and there was no significant statisti- cal difference between gender and ages except 3rd decade. CONCLUSION: It can induce an insufficient external rotation of the femoral component in total knee arthroplasty, if we usually do 3 of external rotation of femoral component from the posterior condylar axis.
Arthroplasty* ; Axis, Cervical Vertebra* ; Femur* ; Humans ; Knee Injuries ; Knee* ; Magnetic Resonance Imaging

Fourtyone patients fo gallbladder and bile duct diseases were studied clinically and sonographically.Tweentynine (Seventyone percent) patients were distributed between age fourty to fiftynine and male to femaleratio was 1:1.4. The order of frequency of biliary tract disease was cholelithiasis, acalculous cholecystitis, CBDstone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faintinternal echoes without shadowing, gallbladder wall thickneing and anechoicity of the gallbladder wall. Instead ofsmall proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seenin ten of nineteen cases of cholelithiasis. On choledocholithiasis, meniscus sign at the junction of the stone andgallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degreeof CBD dilatation was more severe in malignancy than in CBD stones and ascaris in CBD. Sonographic examination wasuseful in detection of gallbladder and bilicary tree pathology and the cause of biliary tract obstruction could beidentified.
Acalculous Cholecystitis ; Ascaris ; Bile Duct Diseases ; Biliary Tract Diseases ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Gallbladder ; Humans ; Male ; Pathology ; Shadowing (Histology) ; Trees ; Ultrasonography

130 cases of the suprarcondylar fractures of the humerus in children were analysed. 60 cases were immobilized with plaster splint without closed reduction. 22 cases were closedly reduced and immobilized with plaster splint. 47 cases were closedly reduced and were fixed percutaneously with K-wires. 39 cases were operatively reduced and were fixed with K-wires. The following results were obtained. 1. The average age was 7.9 years, and the male and female ratio was 2.7: 1. 2. The extension type was 96.2% and the flexion type was 3.8%. 3. The left side (64.6%) was more frequently involved. 4. As associated complications, nerve injury (4.6%), vascular injury (2.3%), open fracture (2.3%), and associated fracture (2.3%). were developed. During treatment incomplete ulnar nerve palsy (2.3%), pin tract superficial infection(3.1%), severe cubitus varus deformity(4.6%), severe limitation of elbow motion(11.6%) were also developed. 5. Final results in the Holmberg's 4 Groups according to Mitchell & Adams' criteria showed that the more the displacement of fracture is increased, the more the poor result is also increased. 6. In spite of the selection of the more severe cases for surgery, the results of the operative cases were better than those achieved by closed reduction in the easier cases. 7. In the displaced fractures, immediate open reduction brings the satisfactory results and minimizies the sequellae.
Child ; Elbow ; Female ; Fractures, Open ; Humans ; Humerus ; Male ; Splints ; Ulnar Neuropathies ; Vascular System Injuries

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.
Allografts ; Autografts ; Chungcheongnam-do ; Congenital Abnormalities ; Follow-Up Studies ; Knee ; Tibia

BACKGROUND: Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrasonography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric parameters and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. METHODS: We obtained abdominal subcutaneous and intra-abdominal fat distance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. RESULTS: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 +/- 0.52 cm, 4.43 +/- 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral fat distance, obtained by the receiver operating characteristic curve analysis, were 4.670 cm in men, 3.695 cm in women diabetic patients. CONCLUSION: Intra-abdominal fat distance measured by US reveals strongly correlated with visceral fat area, which is determined by CT and also well correlated with anthropometric parameters and lipid profiles. We suggest that US provided a better index compared to anthropometry for the prediction of visceral obesity and could be an alternative method for CT for visceral fat determination in diabetic patients.
Abdominal Fat ; Adipose Tissue ; Anthropometry ; Blood Glucose ; Blood Pressure ; Cardiovascular Diseases ; Fasting ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Obesity, Abdominal ; Risk Factors ; ROC Curve ; Supine Position ; Waist Circumference

BACKGROUND: One of major weakness in medical education in Korea is clinical skills has not been uniformly well taught during undergraduate period. To reinforce the basic clinical skill education, we developed introduction to clinical medicine(ICM) course In this study, we described the ICM course development process and the experience. METHODS: We performed comprehensive literature review related to ICM and doctoring curriculum. ICM/OSCE sub-commitee members discussed several time to develop the course. To assess the level of accomplishment of this course, we got feedback from 115 third year medical students by questionnaires. RESULTS: ICM was composed of 9 topics which covers the basic clinical skills. For each topic, three hours per week was allocated, one hour for didactic session and the other 2 hours for practical exercise. Standardized patients were used to teach interview skill. Most of students revealed history taking, abdominal examination, musculo-skeletal system, and interview skill session were valuable learning experience. However, for Gynecology and Pediatric session which were taught by mainly lectures, students evaluated them negatively. INTERPRETATION: This year, we focused on teaching basic clinical skills at ICM. However, our ultimate goal is to develop the ICM course which can allow the students to learn both the art and the science of Medicine.
Clinical Competence* ; Clinical Medicine* ; Curriculum ; Education ; Education, Medical ; Gynecology ; Humans ; Korea ; Learning ; Lectures ; Students, Medical ; Surveys and Questionnaires