We have observed that the companion shadow of the upper rib may be misinterpreted as a small pnemothorax or pleural plaque associated with asbestosis. To observe the radiographic characteristics of the normal companion shadow, we analyzed, on the posteroanterior(PA) chest radiographs, the companion shadow of 50 normal cases. Factors such as occurrence on each rib, the sharpness of the margin, the relative position to the rib, the shape and the thickness were observed. Also, we analyzed the displaced pleura of 4 pneumothorax cases to differentiate their frndings from the findings of normal companion shadows. On 50 normal chest radiographs, 192 compaion shadows were observed on the first to fourth ribs. In 173 of those shadows, the visceral margin of the companion shadow on the second rib simulated pneumothorax more closely than those on any othe rivs due to its apical location and thinness. In six of 50 normal cases, the companion shadow on the first or second rib showed an inw rdly convex lower margin, mimicking pleural plaque. The compaion shadow was suggested on the plain chest radiograph by the following characteristics imultiplicity(47/50), thicker than normal pleura(3/4), persistent on serial filma with the same shape and specific location(4/4).
Asbestosis ; Friends* ; Humans ; Pleura ; Pneumothorax ; Radiography, Thoracic ; Ribs* ; Thinness

Fractures significantly involving the weight-bearing articular surface and the overlying metaphysis of the distal tibia have deserved notoriety as a severe and challenging subject of ankle injuries. It was not until 1963 that the AO group developed principles for open reduction and internal fixation of pilon fracture. But recently, limited internal fixation of the joint surface combined with external fixation may avoid the soft tissue complications associated with formal open reduction and internal fixation. We have treated 22 cases of tibial pilon fracture with biologic principle. The mean follow-up period was two years ranging from one to three years. According to the Riiedi and Allgower classification, three cases were type I, five cases were type II, and fourteen cases were type III Biologic treatment includes combination of internal and external fixation, external fixation alone, or plating was done with careful soft tissue dissection, limited stripping of fracture fragments, and indirect reduction technique. Radiographic results were assessed by Burwell and Charnley criteria. Three cases of type I, three cases of type II and seven cases of type III pilon fractures obtained good anatomic radiographic results. We also assessed the functional results by Mast and Teipner criteria. Three cases of type I, three cases of type II, six cases of type III pilon fractures obtained good functional outcome. We believed that combination of internal and external fixation provides the patient who has a markedly displaced pilon fracture and diaphyseal comminution with the best chance of good clinical result and minimal risks. As such, we believe biologic treatment is excellent for these injuries.
Ankle Injuries ; Classification ; Follow-Up Studies ; Humans ; Joints ; Tibia ; Weight-Bearing

Osteoid Osteoma occurs anywhere in skeleton. They are most common in lower extremity, particularly femur about 40%. Two-thirds of femoral lesions is in the intertrochanter or intracapsular regions of the hip. The lesion is usually cortical and may extend into the periosteal or endosteal surface of the bone. It is rare in the cancellous bone. We experienced a case of osteoid osteoma in intertrochanteric cancellous portion of the femur in 50 year old man. Many complained right hip pain worsend three weeks before his visit. Radiograph shows sclerosis around a lucent nidus in cancellous portion. The lesion did not extend to the endosteal surface. We have removed nidus and surrounding reactive portion completely with curettage. Follow up radiographic results after 20 weeks, showed no evidence of recurrence.
Adult* ; Curettage ; Femur* ; Follow-Up Studies ; Hip ; Humans ; Lower Extremity ; Middle Aged ; Osteoma, Osteoid* ; Recurrence ; Sclerosis ; Skeleton

Fractures in the subtrochanteric region of the femur present more formidable problems in treatment than do other trochanteric fractures, because such severe stresses exit at the fracture site. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recommanded for use in subtrochanteric fractures and each of these devices have advantages in certain types of subtrochanteric fractures, and their selection should be based on the individual fracture anatomy. A total of 20 patients with fracture of the subtrochanteric region of the femur, who were treated by internal fixation with Judet plate between January 1982 and December 1988 have been reviewed. Our conclusions were as follows; 1. Average age was 38 years old and most common cause of injury was traffic accident. 2. Cast immobilization was done after Judet plate fixation. Partial weight bearing ambulation was enabled from POD 10 weeks and full weight bearing ambulation was enabled from POD 16 weeks. 3. 18 in 20 cases, primary bony union was happened and the mean duration of radiological bony union was 24 weeks. 4. 3 cases of complications, metal failure with refracture (2 cases) and screw loosening (1 case), were occured due to early weight bearing in the post operative course. 5. Judet plate fixation was gave satisfactory result in uncomminuted subtrochanteric fracture, especially Seinsheimer's type I, II-A,B,C or Fieldings type I, II. 6. From a consideration of these series, Judet plate showed easy to use, perfect adaptation and rigid fixation. We thought Judet plate is one of a good implants for rigid fixation of subtrochanteric fracture without severe medial cortical disruption.
Accidents, Traffic ; Clinical Study ; Femur ; Hip Fractures ; Humans ; Immobilization ; Internal Fixators ; Walking ; Weight-Bearing

Brain size is a useful parameter describing ontogenic character and function. Despite its potential contribution to functional study and diagnosis of disease, it has been hampered by poor assessment tools in vivo and postmortem changes. Recent development of medical imaging techniques such as MRI and CT enable us to understand brain structures in vivo. Many morphometirc studies of the brain has given us new insights in the field of functional neuroanatomy and neuropsychiatric diseases. In spite of these advances, volumetric data of normal Korean brain is not available yet. As an initial approach to Korean standard brain size, we measured the cerebellar volume between 20 and 80 years old Koreans. The MRI films free from lesions in brain was analyzed and measured by NIH image program. The Korean cerebellar volume were ranged between 86.2cm(3) and 141.3 cm(3) and average male cerebellum volume was significantly larger than that of female[male : 118.2+/-11.2cm(3)] > female : 108.0+/-9.6cm(3), P=0.1021E-07<0.05]. And we could not find volume change according to aging process. This is the first report on normal Korean cerebellar volume and the presence of gender difference in the Korean cerebellar volume. These data will be used for the standard useful in studying cerebellar function and cerebellum associated disorders in the future.
Aged, 80 and over ; Aging ; Brain ; Cerebellum ; Diagnosis ; Diagnostic Imaging ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Neuroanatomy ; Postmortem Changes

Which brain regions participate in musical processing remains controversial. During singing and listening a familiar song, it is necessary to retrieve information from the long-term memory. However, the precise mechanism involved in musical processing is unclear. Amusia is impaired perception, understanding, or production of music not attributable to disease of the peripheral auditory pathways or motor system. We report a case of a 36-year-old right-handed man who lost the ability to discriminate or reproduce rhythms after a right temporoparietal lobe infarction. We diagnosed him as an amusic patient using the online version of Montreal Battery of Evaluation of Amusia (MBEA). This case report suggests that amusia could appear after right temporoparietal lobe infarction. Further research is needed to elucidate the dynamic musical processing mechanism and its associated neural structures.
Adult ; Auditory Pathways ; Auditory Perception ; Brain ; Cerebral Infarction ; Humans ; Infarction* ; Memory, Long-Term ; Music ; Singing

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.
Biopsy ; Diagnosis ; Gastroscopy* ; Humans ; Melanoma* ; Melena ; Neoplasm Metastasis* ; Stomach

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.
Biopsy ; Diagnosis ; Gastroscopy* ; Humans ; Melanoma* ; Melena ; Neoplasm Metastasis* ; Stomach

PURPOSE: To evaluate the functional results of total wrist arthrodesis with the Sauve-Kapandji procedure in the rheumatoid arthritis. MATERIALS AND METHODS: The clinical results of twenty wrists of 17 patients who underwent total wrist arthrodesis with the Sauve-Kapandji procedure for the treatment of the rheumatoid arthritis during the period of February 1996 to May 2003 were analyzed. The patients who were observed for more than 12 months postoperatively were chosen as subjects and the mean follow-up period was 42 months (range, 13 to 100 months). At last follow-up, radiological and functional evaluation were done. For the functional evaluation, the standard patient review questions of Weiss et al. and the Buck-Gramcko/Lohmann score were used. RESULTS: The mean time to clinical fusion of the wrist was 6 weeks. The postoperative range of motion is pronation 68degrees, supination 71degrees. The standard patient review questions of Weiss et al. revealed that 17 cases 85%) were satisfied with the functional results of the procedure. 16 cases (80%) wished that the procedure had been done earlier. The standard patient review questions also showed that maximum improvement in function after the procedure required an average of 6 months (range, 1 to 30 months). On a scale of 1 to 10, the mean score of the subjective overall functional evaluation by the patients was 8.25 points range, 5-10 points). The mean Buck-Gramcko/Lohmann score for the objective functional evaluation was 8.7 points (range, 1-10 points) out of 10 points, corresponding to good result. CONCLUSION: For the treatment of the advanced rheumatoid arthritis of wrist involving radio-carpal, midcarpal, and distal radio-ulnar joint, total wrist arthrodesis with the Sauve-Kapandji procedure was a reliable treatment method. These procedures offer satisfactory subjective and objective functions with few complications.
Arthritis, Rheumatoid* ; Arthrodesis* ; Follow-Up Studies ; Humans ; Joints ; Pronation ; Range of Motion, Articular ; Supination ; Wrist*

Isolated pulmonary Langerhans cell histiocytosis (LCH) is a very rare disease in childhood. We report a case of a 5-month-old girl with isolated pulmonary LCH, who was transferred due to incidental chest x-ray finding of multiple cystic lesions without any clinical symptoms. Chest computed tomography (CT) finding suggested that pulmonary LCH was likely, but evaluations including lung biopsy were negative. At a follow-up visit three months later, we performed bronchoalveolar lavage (BAL) fluid analysis and confirmed the presence of CD1a-positive cells, thereby confirming diagnosis of pulmonary LCH. After completing eight months of chemotherapy, yearly follow-up evaluations were performed and there has been no evidence of reactivation of the disease for four years. Based on our case, we suggest that BAL with immunohistochemical staining can be a valuable modality to eliminate the possibility of infection and other infiltrating disorders, and diagnose pulmonary LCH in case of suspicious pulmonary lesions.
Biopsy ; Bronchoalveolar Lavage ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Infant ; Lung ; Rare Diseases ; Thorax