The purposes of operative treatment in unstable thoracolumbar and lumbar spine fractures are anatomical reduction and stabilization of the fractures and thus promote neurological recovery and early rehabilitation. To achieve these goals, complete preoperative assessment and recognition of the fracture pattern is necessary in addition to good surgical technique. The authors analyzed 47 cases of thoracolumbar and lumbar spine fractures operated from Jan. 1989 to Dec. 1991 at the Department of Orthopaedic Surgery, National Medical Center. All cases were classified according to Denis classification and in deciding the appropriate surgical approach, fracture type, stability, neurologic status and degree of deformity were all considered. Anterior approaches were performed in 23 cases of burst fracture and 3 cases of fracture-dislocation, and posterior approaches were performed in 1 case of compression fracture, 7 cases of burst fracture, 4 cases of seat-belt type injury and 5 cases of fracture-dislocation, In 3 cases of burst fracture and 1 case of fracture-dislocation, both anterior and posterior approaches were combined. With the analysis of postoperative changes in sagittal and coronal angle, translation and degree of rotation, we evaluated the results of operative reduction in terms of restoring normal anatomical configuration of injured spinal segments. So we tried to find the attributing factors in the operative reduction of the thoracolumbar and lumbar spine fractures and suggest the proper surgical approach that provides better reduction and stabilization.
Classification ; Congenital Abnormalities ; Fractures, Compression ; Rehabilitation ; Spine

Acrokeratoelastoidosis of Costa is a rare palmoplantar keratoderma with autosomal dominant inheritance. It is clinically charaeterized by small, firm, yellowish, shiny, translucent papules occumng over the dorsal hands, the knuckles, and the lateral margine of the palms and soles. Histologically, the characteristic features are hyperkeratosis, aeanthosis, and most strikingly, fragmentation of coarse elastic fibers within the dermis. The lesions usually begin in early childhood and progress slowly. We herein report two familial cases of acrokeratoelastoidosis of Costa showing typical clinic1 and histopathological features.
Dermis ; Elastic Tissue ; Hand ; Keratoderma, Palmoplantar ; Wills*

Tegafur is a fluoropyrimidine structurally similar to 5-fluorouracil, used in the treatment of advanced gastrointestinal neoplasms. Mucocutaneous side reactions induced by this agent are rare and include photosensitivity of lichenoid and eczematous types, acral erythema, hyperpigmentation and palmoplantar keratoderma. However, to our knowledge, there has been no report of concurrent development of eruptions of two types in a patient. We describe a female patient with breast cancer, presented with combined features of acral erythema and hyperpigmentation due to oral tegafur.
Breast Neoplasms ; Erythema* ; Female ; Fluorouracil ; Gastrointestinal Neoplasms ; Humans ; Hyperpigmentation* ; Keratoderma, Palmoplantar ; Tegafur*

We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.
Airway Extubation* ; Elasticity ; Gastrectomy ; Hoarseness ; Humans ; Intubation ; Middle Aged ; Recurrent Laryngeal Nerve ; Trachea ; Traction ; Vocal Cord Paralysis* ; Vocal Cords ; Voice

No abstract available.

Pulmonary alveolar proteinosis(PAP) is a rare disease in which the alveolar spaces are filled with an eosinophilic, PAS-positive material, whereas the interstitial architecture of the lung usually remains unaffected. Although a definitive diagnosis is usually made by an open lung biopsy, bronchoalveolar lavage(BAL) cytology may play a decisive role in the diagnosis and therapy of these patients and may spare a patient a more invasive diagnostic procedure. The author presents a patient in whom BAL cytology specimen contained the characteristic globules of amorphous proteinaceous PAS-positive material accompanied by background of rare macrophages and inflammatory cells. Ultrastructural study using BAL specimen can confirm the diagnosis of PAP.
Biopsy ; Bronchoalveolar Lavage* ; Diagnosis ; Eosinophils ; Humans ; Lung ; Macrophages ; Pulmonary Alveolar Proteinosis* ; Rare Diseases

Adenoid cystic carcinoma of the uterine cervix is a rare tumor accounting for less than 1% of all cervical adenocarcinoma. This tumor is characterized by aggressive biological behavior with frequent local recurrence or metastatic spread, postmenopausal onset, and occasional association with conventional squamous cell carcinoma. The cytologic diagnosis of adenoid cystic carcinoma in the uterine cervix is often difficult because of negative smear due to intact overlying mucosa, cytologic findings mimicking endometrial cells, and masquerade as squamous cell carcinoma. Recently we have experienced a case of adenoid cystic carcinoma arising in the uterine cervix, which was identified on the routine Papanicolaou smear and was histologically confirmed by the consequent biopsy. The smear showed abundant cellularity composed of relatively uniform cells. The tumor cells were arranged in small clusters, acini, naked cells, and loose sheets with abortive cribriform pattern. There were scattered globoid basement membrane-like materials and tumor diathesis. The nuclei were pleomorphic and showed hyperchromatic and coarsely granular choromatin with inconspicuous nucleoli. The punch biopsy of the uterine cervix showed typical histologic findings of adenoid cystic carcinoma characterized by tumor nests composed of hyperchromatic uniform basaloid cells, cribriform pattern, and cylindrical hyaline bodies.
Adenocarcinoma ; Adenoids* ; Biopsy ; Carcinoma, Adenoid Cystic* ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis ; Disease Susceptibility ; Female ; Hyalin ; Mucous Membrane ; Papanicolaou Test ; Recurrence

BACKGROUND: The present study estimated healthcare costs of osteoporotic fractures including spine, hip, distal radius and humerus in Koreans over 50 years of age using national claims data. METHODS: Korea National Health Insurance data between 2008 and 2011 was searched for all claims records of outpatient visits or hospital admissions of patients ≥50-year-of-age. Osteoporosis-related fractures were identified using certain the International Classification of Diseases, Tenth Revision codes and site-specific physician claims for procedures in a patient age cut-off value of 50 years. The healthcare costs included acute phase costs accounting for emergency medical care given immediately after fracture, costs due to further hospitalization and surgical procedures, physiotherapy sessions according to the site of the fracture, and outpatient visits in the year after discharge. RESULTS: The total estimated healthcare costs of osteoporotic fractures in 2011 was $722 million. From 2008 to 2011, the total number and healthcare costs of osteoporotic fractures increased 28.9% (from 127,070 to 163,823) and 31.6% (from $549 million to $722 million), respectively. The portion of national health care expenditure was ranged from 2.3% in 2008 to 2.2% in 2011. The mean healthcare cost of osteoporotic fractures per person increased 2.1% from $4,321 in 2008 to $4,410 in 2011.The mean healthcare costs were highest for hip fractures followed by spine, humerus, and distal radius fractures. CONCLUSIONS: Total Healthcare costs of osteoporotic fractures in South Koreans ≥50-year-of-age increased between 2008 and 2011. This trend will likely continue, which is an important health problem in the elderly population and economically.
Aged ; Delivery of Health Care* ; Emergencies ; Health Care Costs* ; Health Expenditures ; Hip ; Hip Fractures ; Hospitalization ; Humans ; Humerus ; International Classification of Diseases ; Korea* ; National Health Programs* ; Osteoporotic Fractures* ; Outpatients ; Radius ; Radius Fractures ; Spine

Gachon Medical School used an oral examination in the pathology course taught during the 2nd semester of the 2000 school year as a performance assessment of students abilities in three areas: comprehension, logic and problem solving. The evaluation instrument was designed in four stages: assessment objectives were determined, abilities to be measured were selected, the assessment instrument was designed, and the examiners' checklist was drafted. The assessment instrument included two gross and two microscopic cases and the checklist was developed using 5 Likert type scales. The students were divided into three groups of 12 to 13 students and two examiners were allocated to each group. The mean score on the oral examination was 3.56(the highest possible score is 5.00). The correlation between examiners was 0.952 while the correlation of gross and microscopic cases was 0.979. Obviously, these data are statistically significant. The correlation between the written examination pathologic-laboratory examination was the highest, that between the oral examination and pathologic-laboratory examination was in the middle, and that between the oral examination and the written examination was the lowest. Students expressed doubts about the objectivity of individual examiners. The high correlation between the examiners' scores and how students scored on other tasks shows that students fears can be assuaged. It is concluded that the oral examination is a powerful tool in measuring students ability, and can be used in a basic medical science course. As an assessment instrument, it is both valid and reliable.
Checklist ; Comprehension ; Diagnosis, Oral ; Humans ; Logic ; Pathology* ; Problem Solving ; Schools, Medical ; Weights and Measures

Background: Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use. Methods: We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures. Results: Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users. Conclusion As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.