Os subfibulare is a accessory bone arround the lateral maleolus, but it is different from many other accessory bones in foot and ankle in its development related to trauma and frequent symptoms of ankle instability. Accessory bone is a developmental anomaly which fails to unite to main secondary ossification center and usually asymptomatic. But os subfibulare is developed by recurrent ankle sprains in younger age or non-union of avulsion fracture of anterior talofibular ligament and causes instability of ankle. We experienced two cases of symptomatic os subfibulare in adolecents and report them with review of literatures.
Ankle ; Ankle Injuries ; Foot ; Ligaments

1. A Case of osteosarcoma is reported which arose 8 years after synovima of the knee had been locally excised. The patient is a 51-year-old housewife who had received irradiation therapy upon her knee for 30 days post-operatively. Following irradiation, asymptomatic latent period lasted 8 years when mass appeared on the site, which was biopsied and diagnosed as osteosarcoma one year later. 2. This case generally suffices the McKennas criterias for irradiation-induced osteosarcoma, 3. It seems to be worthwhile to keep an eye upon the prognosis of this possible case of irradiation- induced osteosarcoma, which is largely reported to be very grave.
Humans ; Knee ; Middle Aged ; Osteosarcoma ; Prognosis ; Sarcoma, Synovial

In order to investigate the efficacy and safety of oral cilazapril, a new angiotensin converting enzyme inhibitor, on essential hypertension, a single daily dose of 2.5 to 5.0mg cilazapril was administered in 30 hypertensive patients with diastolic blood pressure in the range of 95??15mmHg while off all other anti-hypertensive agents for 10 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete blood count with platelet count, blood chemistry by SMA-12 including lactic dehydrogenase and serum electrolytes, and urinalysis were performed at 4th and 10th week of therapy. The electrocardiography was performed at the beginning and the end of treatment period. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) The mean age was 49.2 years, and the ratio of male-to-female was 1 : 1.3. 2) Blood pressure started to fall significantly within 2 weeks of treatment with cliazpril 2.5mg(M+/-S.E., 15.4+/-17.4mmHg vs 138.5+/-23.3, 100.3+/-6.2 vs 89.4+/-6.6, p<0.05), and after 6 weeks of treatment with a mean dosage of 2.84mg. diastolic blood pressure of all subjects was maintained below 90mmHg throughout the rest of trial. 3) Pulse rate or body weight were not significantly changed during the entire treatment period(69.3+/-6.0/min vs 10th week : 69.0+/-7.7, 64.7+/-7.4kg vs 63.6+/-6.7, p>0.05). 4) There were no significant changes in blood chemistry including blood sugar, cholesterol and electrolytes, except mild changes of serum creativine and alkaline phosphatase values. 5) Hematologic findings, urinalysis and electrocardiographic findings remained unchanged. 6)Side effects were mostly mild in nature without potentially serious episodes(dry cough : 20%, indigestion, headache, dizziness, in order), but there was 1 cases in whom the dosage was redyced due to postural hypotension. From the above results, cilazapril with the dosage of 2.5 to 5.0mg was effectvie and well tolerated in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg, and cilazapril seems to be appropriate for monotherapy of mild to moderate hypertensive patients.
Alkaline Phosphatase ; Antihypertensive Agents ; Blood Cell Count ; Blood Glucose ; Blood Pressure ; Body Weight ; Chemistry ; Cholesterol ; Cilazapril* ; Cough ; Dizziness ; Dyspepsia ; Electrocardiography ; Electrolytes ; Headache ; Heart Rate ; Humans ; Hypertension ; Hypotension, Orthostatic ; Oxidoreductases ; Peptidyl-Dipeptidase A ; Platelet Count ; Urinalysis

Between Jan. 1990 and Sep. 1996, 462 renal allografts were carried out at the Ulsan University College of Medicine and Asan Medical Center. This study was undertaken to evaluate a clinicopathologic features, to document a relationship between dosage and duration of the corticosteroids, and to figure out a treatment strategy of avascular necrosis(AVN) of bone in 13 cases of AVN of the femoral head following renal transplantation. A control group of 15 cases were randomly selected among 462 cases of renal allografts to do a comparative study with 13 cases of AVN. The diagnosis of AVN of bone was made on the basis of plain radiographs and MRI or bone scan. 1) The incidence of AVN was 2.8%(13/462). 2) In entire cases, affected site of bone was the femoral head. The main clinical manifestations were hip joint pain, limitation of weight bearing and motion. The mean onset of first bone symptoms of AVN was 5.5 months(1~9 months). 3) Clinical parameters such as age, sex, type and duration of preoperative dialysis, type of donor, rate of body weight change, and duration of follow up had no relation with the prevalence of AVN. 4) The mean total doses of corticosteroids at 1, 3, 6, and 12months post-transplantation were not differ significantly between the two groups. 5) Biochemical parameters, such as BUN/Cr., Ca, /P, /ALP., AST/ALT, cholesterol, glucose, total protein, and albumin had no relation save the preoperative BUN, total protein. 6) The mean duration of diagnosis of this condition were 12.9 months(range, 9~31 months), 6.7 months(range, 1~12 months), 6.9 months(range, 1~14 months) by X-ray, MRI, and bone scan respectively. 4/12(33.3%) cases of AVN was diagnosed by magnetic resonance imaging(MRI) at the time of the first clinical bone symptoms. 7) In AVN group, conservative management were performed in 2 cases, core decompression in 7 cases, and total hip replacement arthroplasty(THRA) were performed in 4 cases of AVN of the femoral head. From this study, we could not illustrate the precipitating factors in transplant recipients using steroid following renal transplantation. We considered that prognosis of AVN depends entirely on early diagnosis using MRI or bone scan, and proper treatment according to the stage of this condition.
Adrenal Cortex Hormones ; Allografts ; Arthroplasty, Replacement, Hip ; Body Weight Changes ; Cholesterol ; Chungcheongnam-do ; Decompression ; Diagnosis ; Dialysis ; Early Diagnosis ; Follow-Up Studies ; Glucose ; Head ; Hip Joint ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Precipitating Factors ; Prevalence ; Prognosis ; Tissue Donors ; Transplantation ; Ulsan ; Weight-Bearing

PURPOSE: The purpose of this study is to present the usefulness of arthrometer (KT-2000) in patients with anterior knee instability and to assist in evaluating an objective prognosis after anterior cruciate ligament reconstruction. MATERIAL AND METHOD: We analyzed the manual maximum anterior displacement, passive anterior displacement at 30Ib force and compliance index between 15Ib and 30Ib, measured by KT-2000 in 82 cases of patient who had unilateral anterior knee instability and 40 cases of volunteers, as control group, who had no history of knee injury. We used the Paired and Independent t-test for statistical analysis. RESULTS: In control group, the mean value of manual maximum anterior displacement is 0.8 +/- 0.9mm, passive anterior displacement, 1.4 +/- 1.3mm and compliance index, 1.1 +/- 1.1mm. In patient group, the mean value of manual maximum anterior displacement is 7.1 +/- 2.7mm, passive displacement, 6.1 +/- 2.6mm and compliance index, 3.8 +/- 1.8mm. We found that the patient group was revealed much higher degree of anterior displacement than the control group (p<0.005) . CONCLUSION: KT-2000 is objective and quantitative in diagnosis of anterior knee instability.
Anterior Cruciate Ligament Reconstruction ; Compliance ; Diagnosis ; Humans ; Knee Injuries ; Knee* ; Prognosis ; Volunteers

Spinal arachnoid cysts are a rare disease with an unknown origin. Because of their broad base, a total laminectomy with or without fusion has been the treatment of the choice. We encountered 5 patients with a spinal arachnoid cyst who were treated by recapping laminoplasty after pars osteotomy. This procedure has not been reported in Korea. All patients showed neurological recovery with no recurrence of the cyst. The findings on the stressed plain film confirmed bony union and stability of the posterior element.
Arachnoid ; Arachnoid Cysts ; Humans ; Korea ; Laminectomy ; Osteotomy ; Rare Diseases ; Recurrence

Morphea is a benign, cutaneous form of scleroderma and morphea profunda is one of its six clinical variants. The solitary morphea profunda is characterized by thickening and hyalinization of subcutaneous tissue and fascia with more dense inflammatory cell infiltrate and paravertebral predominant site. We present a case which showed characteristic histologic findings such as hyalinization of collagen fiber, lymphocytic and plasma cell aggregates and infiltrations.
Collagen ; Fascia ; Hyalin ; Plasma Cells ; Scleroderma, Localized* ; Subcutaneous Tissue

OBJECTIVES: Health Avatar Beans was for the management of chronic kidney disease and end-stage renal disease (ESRD). This article is about the DialysisNet system in Health Avatar Beans for the seamless management of ESRD based on the personal health record. METHODS: For hemodialysis data modeling, we identified common data elements for hemodialysis information (CDEHI). We used ASTM continuity of care record (CCR) and ISO/IEC 11179 for the compliance method with a standard model for the CDEHI. According to the contents of the ASTM CCR, we mapped the CDHEI to the contents and created the metadata from that. It was transformed and parsed into the database and verified according to the ASTM CCR/XML schema definition (XSD). DialysisNet was created as an iPad application. The contents of the CDEHI were categorized for effective management. For the evaluation of information transfer, we used CarePlatform, which was developed for data access. The metadata of CDEHI in DialysisNet was exchanged by the CarePlatform with semantic interoperability. RESULTS: The CDEHI was separated into a content list for individual patient data, a contents list for hemodialysis center data, consultation and transfer form, and clinical decision support data. After matching to the CCR, the CDEHI was transformed to metadata, and it was transformed to XML and proven according to the ASTM CCR/XSD. DialysisNet has specific consideration of visualization, graphics, images, statistics, and database. CONCLUSIONS: We created the DialysisNet application, which can integrate and manage data sources for hemodialysis information based on CCR standards.
Chronic Disease ; Compliance ; Continuity of Patient Care* ; Fabaceae ; Health Information Management ; Health Records, Personal ; Humans ; Information Storage and Retrieval* ; Kidney Failure, Chronic ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Semantics

In Korea, Clonorchis sinensis infection is still highly prevalent because case detection in the field is difficult and the detected cases used to be incompletely cured due to treatment failure. The present study tried to control clonorchiasis in an endemic village by repeated treatments with praziquantel every 6 months and to evaluate sonography as a diagnostic measure. By stool examinations, the egg positive rate in the endemic village was 22.7%, but it decreased to 19.6% at 6 months, 15.1% at 12 months. 12.2% at 18 months, 6.3% at 24 months, 11.4% at 30 months, and 6.3% at 42 months after the beginning of repeated praziquantel administration. The sonography showed 61 (49.6%) positive cases of 123 screened residents: among egg-positives the sonography positive rate was 52.2% and among egg-negatives it was still 49%. The rate among cured cases was 64.3% after 6 months, 50.0% after 12 months, 50.0% after 18 months, and 66.7% after 24 months. In a non-endemic village, 64 residents were found egg-negative by fecal examination, but 20 (31.3%) of them were positive by sonography. The present findings indicate that control of clonorchiasis in an endemic village by repeated praziquantel treatment for 42 months is still insufficient and sonography is of little value for diagnosis of clonorchiasis.
Animal ; Antiplatyhelmintic Agents/administration & dosage* ; Clonorchiasis/ultrasonography* ; Clonorchiasis/prevention & control ; Clonorchiasis/epidemiology ; Follow-Up Studies ; Human ; Korea/epidemiology ; Parasite Egg Count ; Praziquantel/administration & dosage* ; Prevalence ; Sensitivity and Specificity ; Treatment Failure

Endothelin derived from the endothelial cells of microvessel is a potent vasoactive peptide, which has various physiologic actions in many internal organs. The fact that endothelin receptors are present on the osteoblastic cells suggests that endothelin play a role in bone metabolism. This study was done to study the effect of endothelin-1 on osteoblast and the combined effect of dexamethasone and endothelin-1 on osteoblast. Human osteoblasts isolated from ilium were cultured in DME/F12 medium, and divided into 5 groups; Group 1 (control), Group 2(10(-7)M endothelin-1), Group 3(10(-7)M endothelin-1+1:2500 monoclonal antibody), Group 4(10(-7)M dexamethasone+10(-7)M endothelin-1), and Group 5(10(-7)M dexamethasone). [3H]-thymidine uptake in groups was 23373.2+/-2722.4 cpm/well, significantly higher than that of control (P<0.05), and the increase was blocked by the addition of monoclonal antibody to endothelin(group 3). [3H]-thymidine uptake in groups adding steroid with or without endothelin was significantly lower than that of other groups (P<0.05). Group 2 showed marked increase in type I procollagen mRNA compared with other groups, but group 3 and 4 showed no significant effect on the expression of type I procollagen mRNA. In histochemical staining for alkaline phosphatase activity, the cells in groups with steroid were strongly positive in staining, large in size and looked well differentiated. Osteocalcin synthesis was also increased in groups with steroid treatment compared with other groups. This study demonstrated that endothelin-1 stimulated DNA synthesis and the expression of type I procollagen mRNA in human osteoblasts, and inhibited alkaline phosphatase activity, but had no significant effect on osteocalcin. Dexamethasone stimulated alkaline phosphatase activity and osteocalcin synthesis, and inhibited DNA synthesis but had no significant effect on the expression of type I procollagen mRNA. Dexamethasone masked the effect of endothelin-1 on human osteoblastic cells, and the effect of dexamethasone was predominant in the group of a combination of endothelin-1 and dexamethasone.
Alkaline Phosphatase ; Collagen Type I ; Dexamethasone ; DNA ; Endothelial Cells ; Endothelin-1 ; Endothelins* ; Humans ; Ilium ; Masks ; Metabolism ; Microvessels ; Osteoblasts* ; Osteocalcin ; Receptors, Endothelin ; RNA, Messenger