BACKGROUND: A novel technique for the repair of tears of the upper subscapularis tendon—intraarticular knotless fixation—has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. METHODS: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. RESULTS: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. CONCLUSIONS: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Outpatients ; Retrospective Studies ; Shoulder ; Tears* ; Tendons* ; Treatment Outcome

BACKGROUND: The cell mediated immunity has an important role in the pathogenesis of tuberculosis. sIL-2R has been known as a sensitive marker of T lymphocyte activation. Elevated serum levels of sIL-2R have been found in patients with lymphoproliferative disorders, organ transplantation, autoimmune diseases, and various granulomatous diseases. Elevated levels of sIL-2R have been also found in the seam and pleural fluid of the patients with tuberculosis. To evaluate the diagnostic value of sIL-2R in the differentiation of tuberculous pleurisy and. nontuberculous pleurisy. We measured the level of sIL-2R in the sera and pleural fluids of 12 patients with tuberculous pleurisy and 32 patients with nontuberculous pleurisy. METHOD: Samples of pleural fluid and serum were centrifuged at 2500 rpm for 10 min to remove cell pellets. Soluble R-2R was measured with a sandwitch enzyme immunoassay using the Cellfree r Interleukin-2 Receptor Test kit( T-cell science, Inc. Cambridge, MA). RESULTS: The results obtained were as follows: 1) The sIL-2R level in pleural fluid of the patients with tuberculous pleurisy was higher than that of patients with nontuberculous pleurisy(P<0.005). 2) When the sIL-2R level above 5,000 u/ml in pleural fluid was used as the cut-off value to diagnose tuberculous pleurisy, it had a sensitivity of 84.6% and a specificity of 90.9%. 3) The sIL-2R level in the sera of the patients with tuberculous pleurisy was higher than that of patients with bacterial pleural effusions and normal control group(P<0.05) and there was no difference of levels compared with malignant pleural effusions and transudative pleural effusions(P>0.05). 4) In patients with tuberculous pleurisy, the mean concentration of sIL-2R in pleural fluid was higher than that in serum(P<0.005). CONCLUSION: These findings suggest that the measurement of elevated levels of pleural fluid sIL-2R in tuberculous pleurisy may be useful in the differential diagnosis between patients with tuberculous pleurisy and nontuberculous pleurisy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Immunity, Cellular ; Immunoenzyme Techniques ; Interleukin-2* ; Lymphocyte Activation ; Lymphoproliferative Disorders ; Organ Transplantation ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy* ; Sensitivity and Specificity ; T-Lymphocytes ; Transplants ; Tuberculosis ; Tuberculosis, Pleural*

OBJECTIVE: Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively. METHODS: From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes. RESULTS: The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment. CONCLUSION: IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.
Consciousness ; Craniocerebral Trauma ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Headache ; Hematoma, Subdural* ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Symptom Assessment

OBJECTIVE: From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications. Recently, Seoul central district court decided 50% responsibility of the doctors who made a rupture of the aneurysm during coiling (2015Ga-Dan5243104). We reviewed judicial precedents related to cerebral aneurysms in lawsuit using a web search.METHODS: We searched judicial precedents at a web search of the Supreme Court, using the key words, "cerebral aneurysm".RESULTS: There were 15 precedents, six from the Supreme Court, seven from the High Court, and two from district courts. Seven precedents were related to the causation analysis, such as work-relationship. Five precedents were malpractice suits related bad results or complications. Remaining three precedents were related to the insurance payment. In five malpractice precedents, two precedents of the Supreme Court reversed former two precedents of the High Court.CONCLUSION: Judicial precedents on the cerebral aneurysm included not only malpractice suits, but also causation analysis or insurance payment. Attention to these subjects is needed. We also need education of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.
Aneurysm ; Coma ; Decision Making ; Dissent and Disputes ; Education ; Expert Testimony ; Humans ; Insurance ; Intracranial Aneurysm ; Malpractice ; Negotiating ; Rupture ; Seoul

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections that lie within the dura. Intraosseous DAVFs involving diploic venous system are extremely rare. A 46-year-old woman presented with headache and right pulsatile tinnitus for three weeks. The tinnitus started after yelling. Digital subtraction angiography revealed DAVF within the basal portion of right parietal bone along the middle meningeal artery (MMA) groove. The fistula was fed by frontal branch of right MMA and drained into right transverse sigmoid sinus junction through dilated middle meningeal vein. The intraosseous DAVF involving diploic vein was successfully obliterated with Onyx embolization via transarterial route.
Angiography, Digital Subtraction ; Central Nervous System Vascular Malformations* ; Colon, Sigmoid ; Female ; Fistula ; Headache ; Humans ; Meningeal Arteries ; Middle Aged ; Parietal Bone ; Tinnitus ; Veins*

Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.
Actins* ; Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnostic Errors ; Female ; Humans ; Keratosis, Actinic* ; Melanins ; Melanocytes ; Melanoma ; Physical Examination ; Skin ; Thorax

STATEMENT OF PROBLEM: In spite of increasing dental treatment for the disabled, there was no collected data on prosthodontic treatment status and dentists' perceptions in Korea. PURPOSE: The purpose of this study was to research the dentists' perceptions about current prosthodontic treatment status for the disabled in Korea and to suggest public health policies for the disabled. MATERIAL AND METHODS: Total of 68 dentists who have regularly treated the disabled were asked to fill questionnaires regarding prosthodontic treatment for the disabled. RESULTS: 1. 45.6% of dentists felt the necessity of an esthetic prosthesis for the disabled. However, 54.3% of dentists reported the improvement of access to implant,orthodontic and esthetic treatment is needed. 2. Most (79.4%) of the dentists thought it is imperative for the government to support the disabled to maintain adequate oral health by providing at least 50% of charge in their prosthesis. CONCLUSION: Through this research, 97.1% of dentists answered that the current prosthodontic treatment status for the disabled in Korea is poor. This indicated the necessity of the financial support from the government for the disabled.
Dentists ; Fees and Charges ; Financial Support ; Humans ; Korea ; Oral Health ; Prostheses and Implants ; Prosthodontics ; Public Health ; Surveys and Questionnaires

Adenocarcinoma of the ciliary epithelium is a rare tumor, usually occuring in elderly patients who have a history of severe ocular trauma or chronic inflammation. We report an adenocarcinoma of the nonpigmented ciliary epithelium found within the phthisical globe of a 36-year-old female whose eye had been loss of vision since infancy. The mass, measured 4.0 x 4.0 cm, was relatively limited by sclera but had invasion to posterior portion. Histologically, the tumor was a compact mass which consisted of tubular and papillary structures with foci of the pleomorphic area. Strands of cells and individual cells were invested with thick basement membrane that have positivity for periodic acid-Schiff stain. Immunohistochemical staining showed strong reactivity for cytokeratin and epithelial membrane antigen, and focal for neuron-specific enolase and S-100 protein.
Adenocarcinoma ; Adenocarcinoma, Papillary* ; Adult ; Aged ; Basement Membrane ; Epithelium* ; Female ; Humans ; Inflammation ; Keratins ; Mucin-1 ; Phosphopyruvate Hydratase ; S100 Proteins ; Sclera

OBJECTIVE: The purpose of this study was to assess the diagnostic utility of the wrist ultrasonography (USG) in patients with and without carpal tunnel syndrome (CTS). METHODS: Individuals with electrodiagnostically proven CTS patients and healthy control subjects were enrolled prospectively. USG was done 60 wrists of 48 patients with CTS and 36 wrists of 18 controls. The USG analysis included median nerve cross sectional area (CSA) at the level of carpal tunnel inlet. We also evaluated the relationship between median nerve CSA at the level of carpal tunnel inlet and severity grade of nerve conduction test in CTS patients. RESULTS: The median nerve CSA at the level of carpal tunnel inlet was significantly larger in CTS patients (13.6 mm2 versus 7.7 mm2, p<0.0001). And there was an association between median nerve CSA and severity grade of nerve conduction studies (p=0.036). Receiver operating characteristics (ROC) analysis yielded sensitivity of 86.7% and specificity of 88.9% using a cut-off value of 9 mm2. But the specificity was increased to 97.2%, although sensitivity was decreased to 78.3%, when using cut-off value at 10.1 mm2. CONCLUSION: Ultrasonographic measurement of the median nerve CSA at carpal tunnel inlet was useful in diagnosis of CTS. According to ROC analysis, USG is used as a complementary test for electrodiagnostic test.
Bays ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Humans ; Median Nerve ; Neural Conduction ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Wrist

OBJECTIVE: The Korean government has legislated for Medical Dispute Mediation Act in 2011. As a member of medical accident appraisal board, the medical doctor should have well-balanced mind along with the thorough knowledge and experiences on his specialty. METHODS: We evaluated precedents related to the medical accidents of neurosurgery in Korea. We searched precedents in the Korean Supreme Court web site. There were 60 suits of damages in 108 precedents related to the neurosurgery from 1978 to 2010. We found 23 precedents related to neurosurgical treatment. RESULTS: Doctors or medical institutions were liable for damages in 12 precedents including 4 cases of partial responsibility such as solatium. In 11 precedents, liability for damages was disclaimed. The judgment was unrelated to the level of court, dead or disabled, main issue (11 medical error, 7 explanation, 5 negligence and others), or methods of treatment. Liability for damages was usually disclaimed (6 : 2) in 1980s, more frequently claimed (1 : 7) in 1990s, and it became almost same (4 : 3) in 2000s. CONCLUSION: Medical accident appraisal board should be fair in explorations of the accidents. We should prepare to get an expert medical investigator, who has balanced mind, knowledge on the law, and specialized knowledge with experiences on his specialty.
Dissent and Disputes ; Humans ; Informed Consent ; Judgment ; Jurisprudence ; Korea ; Liability, Legal ; Malpractice ; Medical Errors ; Negotiating ; Neurosurgery ; Research Personnel