The calcaneal fractures, the most common tarsal bone fracture are one of the difficult fractures in diagnosis and treatment because of its anatomic complexity and fracture pattern. The authors had taken pre-operative computed tomographies(CTs) and plain X-rays on calcaneal fractures prospectively since March 1992 and the calcaneal fractures were classified according to fracture patterns and locations. Twenty nine fracture were treated with open reduction and internal fixation. Following open reduction and internal fixation of displaced fractures mostly involving posterior facet of subtalar joint or closed reduction with axial pinning by Essex-Lopresti method, we have taken CT on 32 fractures and analyzed anatomic status and observed the relationship between anatomic status and clinical results. The results were as follows: 1. According to Sanders classification, type II was the most common(69%), and then type III(22%), type IV(6%), type I(3%) in frequently. 2. In the relationship between preoperative CT classification and postoperative reduction state, reduction state was in case of more communication. 3. We can expect excellent or good result when the postoperative displacement is within 2mm. 4. The Sanders classification appears to be helpful in predicting prognosis since preoperative CT significantly influenced the clinical outcome, as noted in the relationship between preoperative CT and clinical results.
Classification ; Diagnosis ; Methods ; Prognosis ; Prospective Studies ; Subtalar Joint ; Tarsal Bones

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.
Abscess* ; Adenoma, Chromophobe ; Adult ; Ejaculation ; Humans ; Hydrochlorothiazide ; Leukocytes ; Male ; Pituitary Neoplasms ; Polydipsia ; Polyuria

A number of authors have called attention to the difficulty encountered in diagnosing tumors near the foramen magnum and have formulated symptom complexes in an effort to facilitate early recognition of these lesions. Emphasis has been placed on their bizarre symptoms and on their resemblance to the clinical picture associated with some degenerative diseases of the central nervous system, ruptured cervical disc and cervical spondylosis. Fortunately, it has been known that most of tumors around the foramen magnum are benign, extramedullary and amenable to cure by surgical excision and with minimal morbidity and mortality, provided they are diagnosed early. Recently we experienced a rare case of glioblastoma multiforme at the cervico-medullary junction. A 28-year-old Korean man was admitted to the Dept. of Neurosurgery on May 27, 1974, with 5 months history of cervical and suboccipital pain, and progressive visual disturbance. He had sustained hyperextension injury to his neck 8 months ago, and subsequently developed mild suboccipital and cervical pain which subsided easily with some analgesice. Three months later, he noticed paresthesia and tingling sensation in his upper limbs and anterior chest, especially when he turned his neck to either side. He also had pain in suboccipital region radiating to his both shoulders. Seven months later, he developed sudden paraperesis, poor vision and incoordination with severe suboccipital headache and vomiting. On admission, neurological examination disclosed clear consciousness, bilateral papilledema and abducens nerve palsy and markedly decreased vision. There were clumsiness of movement of both legs, hypesthesia in the face, decreased perception of vibration and position sense below the neck and increased deep tendon reflexes. Fine coordination movements in the upper limbs were disturbed and horizontal hystagmus was also present. Simple skull films showed destruction of the dorsum sellae and the posterior clinoid process, suggesting increased intracranial pressure. Cervical spine films were interpreted as normal. Right carotid angiograms demonstrated marked hydrocephalic patterns, and right vertebral angiograms demonstrated posterior displacement of the tip of the basilar artery and of the choroidal point. Conray ventriculogram showed a sharp filling defect at the level of lateral recess of the fourth ventricle. Suboccipital craniectomy and bilateral laminectomy of the first two cervical vertebrae were performed, disclosing a nodular, meaty, firm mass with some necrosis. The tumor was located posterolateral to the medulla and the spinal cord from the obex to the C2, compressing them and displacing the right cerebellar tonsil upward and laterally. The tumor was removed partially and Torkildsen's shunt was performed. Post-operatively he died suddenly at the end of the second week without any remarkable improvement in symptoms and signs. Pathological report was a glioblastoma multiforme. At autopsy, the tumor was originated from the cervicomedullary junction, extending posteriorly from the obex to the C2 and anteriorly along the brain stem up to the perichiasmatic region.
Abducens Nerve Diseases ; Adult ; Ataxia ; Autopsy ; Basilar Artery ; Brain Stem* ; Brain* ; Central Nervous System ; Cervical Vertebrae ; Choroid ; Consciousness ; Female ; Foramen Magnum ; Fourth Ventricle ; Glioblastoma* ; Headache ; Humans ; Hypesthesia ; Intracranial Pressure ; Laminectomy ; Leg ; Mortality ; Neck ; Neck Pain ; Necrosis ; Neurologic Examination ; Neurosurgery ; Palatine Tonsil ; Papilledema ; Paresthesia ; Proprioception ; Reflex, Stretch ; Sensation ; Shoulder ; Skull ; Spinal Cord ; Spine ; Spondylosis ; Thorax ; Upper Extremity ; Vibration ; Vomiting

PURPOSE: Clinical features of Pancreatic Neuroendocrine Tumors (PETs) vary according to the hormone secreted and to the heredity of the tumors. Malignant PETs are common among nonfunctioning PETs (NFTs) whereas the majority of functioning PETs (FTs) are benign. Our goal was to determine the clinical features and prognosis of PETs stratified by the WHO classification scheme and AJCC-UICC 7TH TNM staging. METHODS: We selected for study 30 patients with PETs, including one case of nesidiolastosis, who presented at our clinic between April 1992 and June 2010. Clinicopathological features were studied retrospectively. PETs were classified as benign, uncertain malignant, well differentiated carcinoma, or poorly differentiated carcinomas by the WHO classification. For statistical analysis, Student's t-test, the Chi-square test, and the Kaplan-Meier method were utilized. RESULTS: Nine cases were FTs and twenty one cases were NFTs. The average size of the FTs was smaller than that of the NFTs (1.71 vs 4.33, p=0.04). The head of the pancreas was most commonly involved (33.3% of FTs; 47.6% of NFTs) but the locations of the tumors were not different. Insulinoma was the most common (66.7%, 6/9) among FTs. The incidence of malignant tumors was 33.3% and 55.0% among, respectively, FTs and NFTs. The 5-year disease-free survival rate of patients with benign PETs (FTs and NFTs), and of patients with functioning well-differentiated carcinomas was 100%. However, the 5-year disease-free survival rates of patients with nonfunctioning well- and poorly-differentiated carcinomas were 66.7% and 0%. CONCLUSION: Among patients with Pancreatic Neuroendocrine Tumors, malignant tumors are more common among NFTs than FTs. Poorly-differentiated carcinomas have a worse prognosis while all FTs regardless of their WHO classification fail to show any disease recurrence.
Disease-Free Survival ; Head ; Heredity ; Humans ; Incidence ; Insulinoma ; Neoplasm Staging ; Neuroendocrine Tumors ; Pancreas ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: We evaluated the humoral and cellular immune response to varicella-zoster virus after vaccination with varicella vaccine (Oka/LG strain). METHODS: The seroprevalence rate of fluorescent antibody to membrane antigen (FAMA) was evaluated among 178 children and 15 adults. After vaccination, seroconversion rate of FAMA, varicella-zoster virus (VZV) specific IgG and cell mediated immune response to glycoprotein I was performed. RESULTS: The seropositive rate of FAMA against VZV in healthy children ages 3 to 6 was 43.1%. A past history of chickenpox illness was confirmed in 15.2% of children who had positive response in FAMA assay in 90.9%. 34.5% of those without a past history of chickenpox had antibodis. The seropositive rate in children vaccinated with varicella vaccine in the past was found to be 46.3% in questionnaire and 44.4% in immunization schedule, lower than that of other studies (greater than 90%). The seroconversion rates in children vaccinated with the Oka/LG were 97.1% with 2,500pfu and 100.0% with 5,000pfu. Antibodies appearing after the Oka/LG vaccination were found to have glycoprotein I zone confirmed by western blotting. The rate of cell mediated immune response was 88.2% in children and 100.0% in adults. CONCLUSION: Further investigation about the effect of the various varicella vaccines used in Korea and about the cause of their immunzation failure after vaccination is needed.
Adult ; Antibodies ; Blotting, Western ; Chickenpox Vaccine* ; Chickenpox* ; Child ; Glycoproteins ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Immunization Schedule ; Immunization* ; Immunoglobulin G ; Korea ; Membranes ; Surveys and Questionnaires ; Seroepidemiologic Studies ; Vaccination ; Vaccines