No abstract available.
Tetany*

Except for the hallux, the human toes classically present three phalanges, distal, middle and proximal. However in 5th toe, only two phalanges are frequently observed. In this condition, known as synarthrosis of the distal interphalangeal joint, the middle and distal phalanges are fused together to appear as symphalangism or biphalangeal 5th toe. Phalanges of 5th toe was investigated in 1,187 cases of Korean radiographs. The incidence of symphalangism was found to be 74% in 1,150 adult. The bilaterality was 99%. To prove proove the genetic basis of the symphalangism, pedigree studies were performed. The symphalangism of the 5th toe was supposed to be an autosomal dominant trait. As an phenotype of recessive homozygote the triphalaneal subjects were traced to investigate their families. Pedigrees of four families in which both parents had triphalangea of 5th toe showed that their offsprings always showed the triphalangea. Therefore, it suggests the symphalangism inherit as a Mendelian dominant trait and it seems to be an example of microevolution or genetic adaptation to bipedalism.
Adult ; Genetics ; Hallux ; Homozygote ; Humans ; Incidence ; Joints ; Parents ; Pedigree ; Phenotype ; Toes*

PURPOSE: As the traditional treatment of the Wassel's type I or II of bifid thumb, Bilhaut-Cloquet, has always been the standard method despite several disadvantages such as tearing of the finger nail, injuries of the growth plate, joint instability, and long visible scarring. To overcome these drawbacks, we applied a modified Bilhaut-Cloquet Method. METHODS: The subjects used for the this study were 10 of 20 patients evaluated. The patients underwent modified methods under every type of Wassel's classification. We designed a central wedge Zig-Zag incision and removed the nail and bony tissues in the remaining digit, but not soft tissue if possible, and transferred the ligaments, tendons, and soft tissue to the remaining thumb from the extra digit. We evaluated the patients' lack of extension, the total ROM of the MP and IP joints, the ROM of IP joints, and the lateral deviations of the reconstructed thumb. RESULTS: The results were encouraging, with all patients showing a good functional and aesthetic outcome. CONCLUSION: The modified method proved a very effective procedure in the treatment of bifid thumb in all types, especially types I or II.
Cicatrix ; Classification ; Fingers ; Growth Plate ; Humans ; Joint Instability ; Joints ; Ligaments ; Polydactyly ; Tendons ; Thumb*

Warthin's tumor is a benign neoplasm that most frequently occurs in the parotid gland. Warthin's tumor shows a tendency of bilateral occurrence, but most of bilateral tumors occur at different time. It usually affects older man and grows slowly. Surgical excision is appropriate treatment for patients with Warthin's tumor and rarely recurs after removal. We report a rare case of bilateral Warthin's tumor which detected at the same time. A 54-year-old man had painless, slowly growing masses on the both mandibular angles. The masses were detected ten years ago. CT scan, ultrasonographic evaluation and fine needle biopsy was performed for preoperative diagnostic study. Superficial parotidectomy was done one after the other at ten-day intervals. After excision, histological examination revealed a mixture of ductal epithelium and a lymphoid stroma. The overlying surface of lymphoid tissue was covered with epithelial cells that was abundant of eosinophilic cytoplasm. Both masses were diagnosed as Warthin's tumor. Postoperatively, the patient did well and had no evidence of recurrence of tumor for 2 years follow-up period. Authors experienced a rare case of bilateral Warthin's tumor which detected at the same time. We recommend stepwise superficial parotidectomy at one or two-week intervals as treatment of bilateral Warthin's tumor.
Biopsy, Fine-Needle ; Cytoplasm ; Eosinophils ; Epithelial Cells ; Epithelium ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Middle Aged ; Parotid Gland ; Recurrence

PURPOSE: Sebaceous carcinoma is a rare malignant tumor derived from the adnexal epithelium of sebaceous glands. This tumor usually occurs on the eyelids, but uncommonly it may occur on the extraocular sites. It is characterized by a tendency of local recurrence and occasional metastasis. Surgical excision is appropriate treatment for patients with sebaceous carcinoma. While this kind of case is rare, we report two cases of sebaceous carcinoma developed on scalp. METHODS: Case 1 was a 69-year-old woman. She visited the hospital with a 1.5 x 2.5 cm sized reddish yellow-colored, slowly growing mass on the left parietal scalp. The mass began at birth and started growing 5 years ago. Case 2 was a 67-year-old woman. She had 2.5 x 3.0 cm sized yellow-colored mass on the right parietal scalp. It occurred at birth and started growing 3 years ago. And the masses had erythematous ulcer with sanguineous discharge. In the beginning, the masses were miliary nodule. RESULTS: CT scan and fine needle biopsy were done. Case 1 and 2 were diagnosed as sebaceous carcinoma. Wide excision with safety margin of 10 mm and split thickness skin graft was done. Histological examination revealed well demarcated, irregular, variable sized tumor lobules. Each lobule was composed of sebaceous and undifferentiated cells. Postoperatively, the patients did well and the lesion did not recur. CONCLUSION: Sebaceous carcinoma is an aggressive malignant tumor. It is often confused with other skin tumors. Authors experienced two rare cases of sebaceous carcinoma developed on scalp. We recommend early wide excision with enough safety margin as treatment of sebaceous carcinoma.
Aged ; Biopsy, Fine-Needle ; Epithelium ; Eyelids ; Female ; Humans ; Neoplasm Metastasis ; Parturition ; Recurrence ; Scalp ; Sebaceous Glands ; Skin ; Transplants ; Ulcer

PURPOSE: Hook nail deformity is caused by inadequately supported nail bed due to loss of distal phalanx or lack of soft tissue, resulting in a claw-like nail form. A composite graft from the foot bencath the nail bed gives adequate restoration of tip pulp. METHODS: From September of 1999 to March of 2004, six patients were treated for hook nail deformity and monitored for long term follow up. Donor sites were the lateral side of the big toe or instep area of the foot. We examined cosmetic appearance and nail hooking and sensory test. The curved nail was measured by the picture of before and after surgery. RESULTS: In all cases, composite grafts were well taken, and hook nail deformities were corrected. The curved nail of the 4 patients after surgery were improved to average 28.7 degrees from average 55.2 degrees before surgery. The static two point discrimination average was 6.5mm and the moving two point discrimination average was 5.8mm in the sensory test. CONCLUSION: Composite graft taken from foot supports the nail bed with the tissue closely resembling the fingertip tissue, making it possible for anatomical and histological rebuilding of fingertip.
Congenital Abnormalities* ; Discrimination (Psychology) ; Follow-Up Studies ; Foot ; Humans ; Tissue Donors ; Toes ; Transplants*

INTRODUCTION: While uncommon, humeral head osteonecrosis is an indication for arthroplasty when the humeral head collapse is advanced. The current authors report the short-term clinical results of 7 hemiarthroplasties to treat humeral head osteonecrosis. MATERIALS AND METHODS: This study focused on 7 reconstructed shoulders of 5 patients whose humeral head osteonecrosis was treated with hemiarthroplasty. The postulated causes were alcohol-induced (4 cases) and steroidinduced (3 cases). The minimum follow-up was 12 months. This study compared the preoperative and postoperative shoulder pain, range of motion, and ASES scores. The postoperative patient satisfaction was assessed. RESULTS: The level of pain during exercise was reduced from a preoperative average of 7.6 to a postoperative average of 1.9. The range of motion, in terms of forward flexion, abduction, and external rotation, improved from preoperative averages of 105.7degrees, 80degrees, and 22.1degrees to postoperative averages of 146.6degrees, 139.3degrees, and 44.3degrees, respectively. The ASES scores increased from a preoperative mean of 39.0 to a postoperative mean of 84.1. The patients' ratings of the outcomes were excellent (5 cases) and good (2 cases). CONCLUSIONS: These short-term results indicate that hemiarthroplasty is a reliable treatment method for humeral head osteonecrosis improving shoulder pain, range of motion, and patient satisfaction.
Arthroplasty ; Follow-Up Studies ; Hemiarthroplasty* ; Humans ; Humeral Head* ; Osteonecrosis* ; Patient Satisfaction ; Range of Motion, Articular ; Shoulder ; Shoulder Pain

PURPOSE: Median nerve entrapment syndrome within carpal tunnel is usually called carpal tunnel syndrome and it is the most common form of peripheral nerve entrapment syndrome. Many factors such as diabetes mellitus, hypothyroidism, hormonal replacement theraphy, corticosteroid use, rhematoid arthritis and wrist fractures may cause carpal tunnel syndrome. To the best of our knowledge, this is the first case report of median nerve entrapment syndrome due to adhesion of laceration wound after suicidal attempt. METHODS: A 28-year-old woman presented with a sensory change and thenar hypotrophy on her left hand. On her history, she attempted suicide by slashing her wrist. Initial electromyography (EMG) showed that the nerve conduction velocities of median nerve was delayed. Therefore, we performed surgical procedures. When exploration, Fibrous scar tissue observed around the median nerve but nerve had not been injured. Transcarpal ligament was completely released and adjacent fibrous tissue was removed to decompress the median nerve. RESULTS: The postoperative course was uneventful until the first year. Opposition difficulty and thenar hypotrophy were improved progressively after the surgery. Sensory abnormality was slowly improved over one year. CONCLUSION: We report a case of median nerve entrapment syndrome that was caused by adhesion of laceration wound after suicidal attempt. This is an unusual cause of median nerve entrapment syndrome, the symptoms were relieved after transcarpal ligament release and fibrous scar tissue removal.
Adult ; Arthritis ; Carpal Tunnel Syndrome ; Cicatrix ; Diabetes Mellitus ; Electromyography ; Female ; Hand ; Humans ; Hypothyroidism ; Lacerations ; Ligaments ; Median Nerve ; Neural Conduction ; Peripheral Nerves ; Suicide, Attempted ; Wrist

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.
Bursitis ; Friction ; Humans ; Ribs ; Sarcoma ; Scapula ; Shoulder ; Shoulder Pain ; Stress, Mechanical

Varix of the digit is generally defined as an enlarged, tortuous palmar digital vein with or without thrombus within it. It usually presents as a firm, blue mass on the volar aspect of the finger. Mechanical compression or chronic trauma to veins on the volar surface of a digit appears central to the pathogenesis of this lesion. Aging phlebectasia has also been considered as a cause of this lesion in the elderly. A tourniquet test may be useful in demonstrating the presence of a digital varix, but it is confirmed by postoperative microscopic examination. Excision of a symptomatic lesion has proven to be curative. We report two cases of symptomatic digital varix which developed in the fourth finger with a review of literatures.
Aged ; Aging ; Fingers ; Humans ; Thrombosis ; Tourniquets ; Varicose Veins ; Veins