Hallux valgus is a complex deformity consisting of more than a 20° valgus angle of the first metatarsophalangeal joint. And more than 9° between the first and second metatarsals as well as bursal hypertrophy over the medial eminance of the first metatarsal head(bunion). Many surgical procedures have been available for treating the hallux valgus complex. Johnson and Coreless have acquired sufficiently good results in modifying the Mitchell osteotomy into the chevron osteotomy. They recommend the chevron osteotomy for the hallux valgus complex with the following patient profile : younger than 50 years old, hallux valgus angle less than 40°, the first-second intermetatarsal angle less than 20°. This procedure consists of 1) medial eminance removal, 2) V-shaped intracapsular osteotomy through the first metatarsal head, 3) lateral displacement of the capsular fragment, 4) removal of the resulting projection of the first metatarsal, and 5) medial capsulorrhaphy. Our results of eleven cases of the hallux valgus deformity which were treated by the chevron osteotomy during the period form July 1985 to Februsary 1988, in the Orthopedic Department of Keimyung University Dongsan Medical Center were as follows. 1. The average age at surgery was 43 years. 2. The average valgus angle was 38° and the first-second intermetatarsal angle was 15° preoperatively. They were correted to 19° and 10° respectively. 3. All cases had complained of severe metatarsalgia preoperatively. 4. The metatarsalgia subsided in all cases, and no avascular necrosis or nonunion was found.
Clinical Study ; Congenital Abnormalities ; Hallux Valgus ; Hallux ; Head ; Humans ; Hypertrophy ; Metatarsal Bones ; Metatarsalgia ; Metatarsophalangeal Joint ; Necrosis ; Orthopedics ; Osteotomy

Sensation is the key element that allows the fingertip to participate effectively in virtually all hand functions. Therefore, it is very important to restore sensation as well as well padded, durable skin coverage following severe fingertip injuries. Many ingenious operations have been described to provide the fingertip with sensate coverage. Among them, the innervated cross-finger flap, reported by Cohen et al. in 1983, is very effective and successful in reconstruction of severe fingertip injuries, We report five cases of severe fingertip injuries treated with innervated cross-finger flap. The results are as follows : 1. The level of sensory return and the functional result is excellent in those fingertips reconstructed with the innervated cross-finger flap. 2. Mean time for flap detachment is 16 days post operative and local anesthesis at outpatient department is sufficient. 3. Four of five treated patients achieved excellent sensibility with measurable two-point discrimination(mean 5.0 mm) and ability to recongnize textures and objects.
Fingers ; Hand ; Humans ; Outpatients ; Sensation ; Skin

A 55-year-old Korean female patient who presented with longitudinal black pigmentation affecting the right thumbnail is described. Direct microscopic examination of nail tissue in 15% potassium hydroxide and cultures on Sabourauds glucose agar revealed Candida species. Cardida species as a cause of longitudinal melanonychia has, to our knowledge, been described only once in the literature. Our case may be the second one.
Agar ; Candida* ; Female ; Glucose ; Humans ; Middle Aged ; Pigmentation ; Potassium

The posterior cruciate ligament is an anatomically and biomechanically complex structure. PCL injuries are reported to occur in 1-40% of acute knee injuries, with isolated PCL tear, less common than PCL tears combined with other Iigament injuries. Controversy exists concerning the geatment of the PCL injures. Recently, arthroscopic techniques of PCL reconstruction are becoming nore refined and reproducible. Between July 1993 and May 1995, 25 operations for PCL rupture were performed in our hospital. At the follow-up examinations we noted mild to moderate posterior instablilty which was not noted at the time of operation and during the immediate postoperative period. We reviewed type (if injuries, amplitude of initial posterior tibia1 translation, surgical techniques, which seemcd to be in relation ivith the postoperative instabilities. At final follow-up, the mean Lysholm knee score was 86 points, and the posterior tibial translation 6.5mm on posterior stress radiographs. The ligament augmentation device provided no benefit. The ideal positioning and fixation of the graft and protection of the graft from abrasion seemed to be important to get a good results.
Follow-Up Studies ; Knee ; Knee Injuries ; Ligaments ; Patellar Ligament* ; Posterior Cruciate Ligament ; Postoperative Period ; Rupture ; Transplants*

PURPOSE: This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS: We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS: The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION: Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
Ampulla of Vater ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Common Bile Duct ; Cystic Duct ; Gastric Emptying ; Humans ; Medical Records ; Neoplasms, Second Primary ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pathology ; Reoperation ; Retrospective Studies ; Survival Rate

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

Protein-calorie malnutrition is common in CAPD patients and is associated with increase in morbidity and mortality in CAPD patients. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein losses through peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross- sectional study on clinically stable 115 patients (63 males and 52 females) who have been on CAPD for more than 2 years, and assessed nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Patients were divided into 4 groups according to the results of standard peritoneal equilibration test (PET). The results were as follows: 1) The patients were divided into 4 groups according to the PET results: high transporter (n=16, 14%), high average transporter (n=38, 33%), low average transporter (n=50, 43%), and low transporter (n=11, 10%). 2) The mean age of the patients was 50.1+/-11.6 years (range, 19-75) with sex ratio (M:F) 1.2:1 and mean duration of dialysis was 57.5+/-27.8 months (range, 24-135). The mean body weight (Bwt) was 59.2+/-8.9kg, percent ideal body weight (%IBW) was 104.7+/-15.6%, %lean body mass (LBM)/Bwt was 82.1+/-11.1%, and malnourished patients by subjective global assessment (SGA) were 32.2% (38/115). 3) The mean BUN, creatinine, total protein, and albumin level of the patients were 54.5+/-13.1mg/dL, 12.3+/-3.0mg/dL, 6.7+/-0.8g/dL, and 3.8+/-0.6g/dL, respectively. 4) There were no significant differences in age, sex ratio, CAPD duration, peritonitis rate, %LBM/ Bwt, and SGA among the 4 groups. 5) Total protein (g/dL) and albumin (g/dL) levels in high transporters were 6.4+/-0.5, 3.5+/-0.4, respectively, and they were significantly lower than those of low transporters (7.2+/-0.6, 4.2+/-0.5) (P<0.05). 6) 24 hour dialysate protein (g/day) and albumin (g/day) losses were significantly higher in high transporters (8.10+/-1.85, 4.19+/-1.23) compared to those of low transporters (5.07+/-1.85, 2.78+/-0.99) (P<0.05). 7) The level of IGF-1 (ng/mL) was significantly lower in high transporters (150.5+/-86.2) compared to that of low transporters (310.3+/-162.1) (P<0.05). 8) The level of BUN (mg/dL), Cr (mg/dL) were also lower in high transporters (45.4+/-13.1, 10.1+/-2.0) than those of low transporters (61.6+/-18, 14.7+/-2.7), but there were no significant differences in Hct, total cholesterol, prealbumin, and transferrin among the 4 groups. 9) There were no statistically significant differences in Kt/Vurea, RRF, NPCR, dietary calorie and protein intakes among the 4 groups. 10) Anthrometric parameters such as TSF, BSF, MAC and LBM measured by three different methods (LBMCr, LBMimp, LBManthro) didn't show any significant differences among the 4 groups. In conclusion, increased peritoneal permeability may not adversely affect SGA and anthropometric status of long-term CAPD patients, although it is associated with lower serum albumin, creatinine, and IGF-1 level. Clinical significance of these findings remains to be elucidated.
Body Weight ; Cholesterol ; Creatinine ; Dialysis ; Humans ; Ideal Body Weight ; Insulin-Like Growth Factor I ; Male ; Malnutrition ; Membranes ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Permeability ; Prealbumin ; Protein-Energy Malnutrition ; Serum Albumin ; Sex Ratio ; Transferrin ; Urea

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies

BACKGROUND: We described a surgical method for osteosynthesis and reported the resultant strength after application of a PHILOS plate through the anterolateral approach for the treatment of fractures of the distal humerus. METHODS: Between February 2010 and March 2012, open reduction and internal fixation operations with the PHILOS plate for treatment of fracture of the distal humerus were performed on a total of nine patients (five men, four women). The mean age was 40.8 years (range, 24-50 years), and the average follow-up period was 9.1 months (range, 6-15 months). Clinical evaluations were performed 6 months after the operation. Clinical assessment included determination of the range of motion of the elbow, the Mayo and Oxford elbow scores, and any postoperative complications. RESULTS: Fracture union was noted in all patients, with an average period of 12.4 weeks. The average Mayo elbow and Oxford elbow scores were 87.2 (of a total of 100) and 43.3 (of a total of 48), respectively. For the postoperative range of motion of the elbow, all patients showed complete recovery to the preoperative range of motion. No other conditions, such as neurolepsis, plate breakage, or rotational deformity, were observed. CONCLUSIONS: Open reduction and internal fixation of distal humerus fractures with a PHILOS plating system via anterolateral approach can be effective. A high rate of union with good outcomes can be assumed.
Congenital Abnormalities ; Elbow ; Follow-Up Studies ; Fracture Fixation ; Humans ; Humeral Fractures ; Humerus* ; Male ; Postoperative Complications ; Range of Motion, Articular

Goltz syndrome, also known as focal dermal hypoplasia syndrome, is a rare congenital mesoectodermal disorder. Two cases, which we experienced, showed erythematous, tan skin rashes and atrophic scars on the whole body, but there were some differences in clinical manifestations. Histopathologic findings in both cases showed diminution in the thickness of the dermis with subcutaneous fat extending upward to the epidermis. Therefore, we report a comparison of two cases of Goltz syndrome, especially with respect to clinical manifestations.
Cicatrix ; Dermis ; Epidermis ; Exanthema ; Focal Dermal Hypoplasia* ; Subcutaneous Fat ; Triacetoneamine-N-Oxyl