The purpose of this study was to assess the results of passive release of the pulley with needle under local anesthesia performed at the out patient department. There were 68 fingers of 54 patients. Fifteen patients(27.8 %) were male and 39 patients(72.2 %) were female. Involved fingers were 28 thumbs(41.2 %), 7(10.3 %) index fingers, 14(20.6 %) middle fingers, and 19(27.9 %) ring fingers. Ages were varied-between 41 years and 61 years old. Rheumatoid fingers were 12(17.6 %). The others had no underlying disease. An 18 gauge needle was introduced distal to the palpable nodule. The pulley was released passively when the PIP joint was extended. The follow-up period was 4.5 years on average(range; 1-8 years). At final follow-up local recurrence was noted in 1-2 weeks in 7 cases(10.3 %), which was due to technical fault in early trial cases. The patients complained of pain for a few days and mild tenderness for less than 2 weeks. In three cases adhesion occurred, which was resolved in a week by maniqulation. There was no difference between rheumatoid arthritis and the other underlying diseases as far as rate of recurrence was concerned. From these results it would be suggested that the passive release of pulley with needle is an effective method for the treatment of adult trigger finger.
Adult ; Anesthesia, Local ; Arthritis, Rheumatoid ; Female ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Male ; Methods ; Needles ; Recurrence

No abstract available.
Child* ; Cranial Irradiation* ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

PURPOSE: To evaluate surface configuration of intervertebral disc on three dimensional CT. MATERIALS AND METHODS: Three dimensional surface images reconstructed from CTscans(1 mm thick) of 20discs in 14 healthy adults were reviewed. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Local irregularity incidence, pattern in radial, concentric, or mixed form, size, location, and extension were observed. Incidence and severity ranges in 4 grades of general irregularity, and peripheral width relative to central radius were evaluated. RESULTS: Normal disc mostly showed smooth surface with few display of small local irregularity(6/20) which was mainly radial in pattern(4/5), posterolaterally located(4/6), and confined within peripheral zone(5/6). General irregularity displayed(5/20) was all grade I and peripheral width was 0.82 of central radius. CONCLUSION: Normal disc shows smooth surface but few may display small local irregularity maybe due to very early degenerative change.
Adult ; Humans ; Incidence ; Intervertebral Disc* ; Radius

Spontaneous rupture of the quadriceps tendon has heen rarely reported. We experienced four knees of 3 patients. Two patients with chronic renal failure(CRF) had been treated with peritoneal dialysis and the other patient was healthy without significant medical problem. In the CRF patients, laboratory studies were coincided with secondary hyperparathyoidism. Radiologic and operative findings suggested that the repeated minor trauma caused avulsion fracture of the bone near the insertion site of the tendon. Histologic findings revealed no elastosis of the tendon and no deposit of amyloid in the quadriceps tendon. In the non-CRF case, there was normal lahoratory data, and the rupture occurred at the musculotendinous junction, suggesting sudden contracture of the muscle causing failure without trauma history. All cases were treated successfully with open repair of the quadriceps tendon. It could be summarized that the site of spontaneous rupture in the CRF and normal patient were different.
Amyloid ; Contracture ; Humans ; Kidney Failure, Chronic ; Knee* ; Peritoneal Dialysis ; Rupture ; Rupture, Spontaneous* ; Tendons*

Bone grafts are an integral and important aspect of craniofacial reconstruction. Rips, tibia, and iliac bone have traditionally used as donor site but each of these has various problems, however using to the calvarial bone as a donor site has several advantage. These are as follows; there are abundance of material, easy to reach the donor site through coronal incision, minimal pain of donor area, less functional inability, shorter hospitalization, no need of immobilization, hidden scar at donor site, no secondary deformity and appropriate curvature obtained properly selected. From March to December 1987, we experienced three cases of autogenous calvarial bone graft such as congenital saddle nose deformity, fibrous dysplasia on the right side frontal bone, and deviated nose. The results were very excellent without any significant complication. The detail technique of autogenous calvarial bone graft and its advantages compared with the traditional methods of bone grafts are discussed.
Cicatrix ; Congenital Abnormalities ; Frontal Bone ; Hospitalization ; Humans ; Immobilization ; Nose ; Tibia ; Tissue Donors ; Transplants*

Mandibular prognathism was defined by Johe Hunter as follows : 'The lower jaw projecting too far forwards so that the foreteeth pass before those of upper jaw, therefore disfigurement and malocclusion are the two of facial main characteristics.' Mandibular ramus osteotomy by vertical osteotomy or sagittal splitting osteotomy recently has come into more common use. Although preoperative and postoperative orthdontic management is indispensable in surgery of this type, we occasionally encounter patients who are intolerant to a long duration of orthodontic treatment and intermaxillary fixation. We describe surgical refinement accomplishing mandibular anterior segmental osteotomy, recession genioplasty by horizontal osteotomies and decortication of the anterior portion of the bony bar for a minor degree of mandibular prognathism. In results, the amount of setback is limited to 4 to 5mm, no intermaxillary fixation is required and no orthodontic treatment, in this operation, is needed. This procedure can obtain a rapid aesthetic improvement. We used this preocedure in 8 patients (3 males and 5 females) with a mild mandibular prognathism. No major complications occurred throughout the follow-up period except transient paresthesia of the mental nerves, otherwise all patients were satisfied with the result.
Follow-Up Studies ; Genioplasty* ; Humans ; Jaw ; Male ; Malocclusion ; Osteotomy* ; Paresthesia ; Prognathism*

No abstract available.
Pressure Ulcer*

In the treatment of malleolar fracture, anatomical reduction and rigid internal fixation are essential to prevent the complications such as infection, malunion or nonunion, traumatic arthritis, skin necrosis and joint contracture. But it is often difficult to obtain rigid fixation for medial malleolar fracture because of its comminution or thin cortex with osteoporosis. Generally, two operative methods are available for medial malleolar fracture, which are malleolar lag screw fixation and tension band wiring. The purpose of this paper is to analyze which operative method is better for anatomical reduction and rigid fixation and has less postoperative complications for medial malleolar fractures. From March 1992 through March 1995, 88 patients had undergone surgical intervention for medial malleolar fractures. The patients were divided into 2 groups according to operative method for medial malleolar fracture. For one group, malleolar lag screw together with or without a K-wire was used in 48 patients, and for the other group, tension band wiring was used in 40 patients. The average follow-up periods were 14 months in screw fixation group and 13 months in tension band wiring group. The average union time were 15.4 weeks (8-17 weeks) in screw fixation group and 12.2 weeks (6-15 weeks) in tension band wiring group. 27 cases (56%) showed excellent result in screw fixation group and 30 cases (75%) in tension band wiring group. In the patient over 50 years old, 2 (15%) in 13 cases showed excellent result of screw fixation group, while 5 (45%) in 11 cases of tension band wiring group. We concluded that tension band wiring is a better method for medial malleolar fracture to obtain early union and to prevent postoperative complications, especially in the elderly patient.
Aged ; Arthritis ; Contracture ; Follow-Up Studies ; Humans ; Joints ; Middle Aged ; Necrosis ; Osteoporosis ; Postoperative Complications ; Skin

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia ; Body Mass Index ; Catheterization ; Humans ; Jugular Veins* ; Observational Study ; Palpation ; Prospective Studies ; Skin ; Ultrasonography ; Valsalva Maneuver* ; Veins

Darier's disease is a well-known genodermatosis characterized by recurrent waxy, hyperkeratotic papules usually occurring over the seborrheic area. The major histopathological changes are characteristic acantholysis and dyskeratosis which are diagnostic of the disease with typical clinical features. There are less common variants including the hypertrophic, vesicobullous and linear type. However, comedonal lesions are very rare. We report an unusual case of Darier's disease, which showed prominent comedonal papules and plaques over the face, scalp and upper trunk with the typical findings of Darier's disease.
Acantholysis ; Darier Disease* ; Scalp