We have reviewed seven cases of fracture-separation of the distal humeral epiphysis, one of which was initially misdiagnosed as a fracture of the lateral condyle. There were difficulties in making the diagnosis. The injury must be distinguished from an elbow dislocation and a fracture of the lateral humeral condyle. All seven patients revealed posteromedial displacement of the distal humeral epiphysis on initial x-rays. Three patients were treated by closed reduction and cast immobilization, and four patients by open reduction and internal fixation. All three patients with conservative treatment had slight cubitus varus (under 5 degrees). Two patients with operative treatment had significant deformities of the elbow, one 25 degrees of valgus and one 20 degrees of varus. In treatment of these injuries, accurate evaluation of the state of reduction is most important. We got acceptable results with a conservative treatment.
Child* ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Elbow ; Epiphyses* ; Humans ; Immobilization

No abstract available.
Arthroplasty, Replacement, Hip* ; Gait*

PURPOSE: This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. MATERIALS AND METHODS: The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. RESULTS: Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were <5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. CONCLUSION: The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

BACKGROUND AND OBJECTIVES: To investigate reliability of the air caloric test compared to the water caloric test and to determine whether anatomical alterations due to chronic otitis media (COM) influence air caloric response. MATERIALS AND METHODS: Fifty-six subjects without vestibulopathy (24 healthy individuals as control group and 32 patients with unilateral COM as experimental group) were included. The bithermal water and air caloric test were sequentially conducted in control group. The bithermal air caloric tests, high-resolution temporal bone computed tomography and endoscopic photography of the ear drum were obtained from experimental group. RESULTS: Although maximal slow phase velocities and time to reach peak velocity using water irrigation were significantly higher and shorter, respectively, than those by air irrigation in normal subjects, caloric parameters on air caloric test agreed well with those of water caloric testing. However, inverted nystagmus occurred in 16 ears of 16 subjects, which was predominantly presented during warm air stimulation in the com patient group. The large tympanic membrane perforation and asymmetrical mastoid pneumatization were significant parameters affecting caloric response. The presented prediction model for cold-induced mspvs corresponded with observed values according to mastoid pneumatization. CONCLUSION: Although the air caloric stimuli resulted in a reliable response in healthy subjects, air caloric results among com patients affected by anatomical alteration as well as irrigation temperature. Presented mathematical model for cold induced mspv could serve as a good reference in measuring true vestibular function in com patients.
Caloric Tests ; Cold Temperature ; Ear ; Humans ; Mastoid ; Models, Theoretical ; Otitis ; Otitis Media ; Photography ; Temporal Bone ; Tympanic Membrane Perforation ; Water

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.
Adult ; Breast Neoplasms/surgery* ; Female ; Human ; Mastectomy/rehabilitation* ; Middle Age ; Postoperative Complications ; Prospective Studies

While Raoultella planticola is a rare cause of human infection, we experienced a case of severe cholangitis caused by R. planticola. A 75-year-old male patient with cancer of the pancreatic head was admitted and found to have cholangitis. Following performance of percutaneous transhepatic biliary drainage for decompression and initiation of empirical antibiotics with cefotaxime and metronidazole. R. planticola, which was susceptible to cefotaxime, was isolated from both bile and blood. Despite administration of prompt and appropriate antibiotic therapy, the patient died 10 days after admission. We herein describe the first case of cholangitis caused by infection with R. planticola.
Aged ; Anti-Bacterial Agents ; Bile ; Cefotaxime ; Cholangitis ; Decompression ; Drainage ; Head ; Humans ; Male ; Metronidazole ; Pancreatic Neoplasms ; Sepsis

Klinefelter's syndrome is characterized by small testes, azoospermia, gynecomastia, and elevated levels of plasma gonadotropins in men with two or more X chromosomes. Previous investigators reported that patients with Klinefelter's syndrome are predisposed to the development of a non-seminomatous germ cell tumor in the mediastinum. It is suggested that this linkage may be due to the hormonal imbalance in Klinefelter's syndrome and consequently, the formation of dysgenetic germ cell and/or abnomal migration of germ cell. We report here a case of Klinefelter's syndrome in a 24-years-old man who was presented with anterior mediastinal mass. The clinical and laborarotory findings were compatible with Klinefelter's syndrome and he was found to have 47 XXY karyotype. Pathological findings for mediastinal mass revealed mixed germ cell tumor composed of mature cystic teratoma and endodermal sinus tumor. He was treated with cis-platin containing chemotherapy and followed up in partial remission.
Azoospermia ; Drug Therapy ; Endodermal Sinus Tumor ; Germ Cells* ; Gonadotropins ; Gynecomastia ; Humans ; Karyotype ; Klinefelter Syndrome* ; Male ; Mediastinum ; Neoplasms, Germ Cell and Embryonal* ; Plasma ; Research Personnel ; Teratoma ; Testis ; X Chromosome

PURPOSE: Multidrug resistance-associated protein (MRP) 2 is a glutathione conjugate in the canalicular membrane of hepatocytes. Early graft damage after liver transplantation (LT) can result in alteration of MRP2 expression. The purpose of this study was to evaluate the relationship between the pattern of MRP2 alteration and graft outcome. METHODS: Forty-one paraffin-embedded liver graft tissues obtained by protocol biopsy within 2 months after LT; these were stained using monoclonal antibodies of MRP2. We selected 15 live donor biopsy samples as a control, that showed homogenous canalicular staining for MRP2. The pattern of canalicular MRP2 staining of graft was classified into 3 types: homogenous (type C0), focal (type C1), and no (type C2,) staining of the canaliculi. RESULTS: In total, 17.1% graft tissues were type C0, 36.6% were type C1, and 46.3% were type C2. The median operation time was longer in patients with type C2 (562.6 minutes) than in patients with type C0 (393.8 minutes) (P = 0.038). The rates of posttransplant complications were higher in patients with type C2 (100%) than in patients with type C0 (42.9%) and C1 (73.3%) (P < 0.001). CONCLUSION: MRP2 expression pattern was altered in 82.9% after LT. The pattern of MRP2 alteration was associated with longer operation time and higher rates of post-LT complications.
Antibodies, Monoclonal ; Biopsy ; Glutathione ; Hepatocytes ; Humans ; Liver Transplantation* ; Liver* ; Membranes ; Multidrug Resistance-Associated Proteins ; Tissue Donors ; Transplants*

Objectives: The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). Methods: We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. Results: This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment methods and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate. Conclusion While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Purpose: Targeted next-generation sequencing (NGS) panels for solid tumors have been useful in clinical framework for accurate tumor diagnosis and identifying essential molecular aberrations. However, most cancer panels have been designed to address a wide spectrum of pan-cancer models, lacking integral prognostic markers that are highly specific to gliomas. Materials and Methods: To address such challenges, we have developed a glioma-specific NGS panel, termed “GliomaSCAN,” that is capable of capturing single nucleotide variations and insertion/deletion, copy number variation, and selected promoter mutations and structural variations that cover a subset of intron regions in 232 essential glioma-associated genes. We confirmed clinical concordance rate using pairwise comparison of the identified variants from whole exome sequencing (WES), immunohistochemical analysis, and fluorescence in situ hybridization. Results: Our panel demonstrated high sensitivity in detecting potential genomic variants that were present in the standard materials. To ensure the accuracy of our targeted sequencing panel, we compared our targeted panel to WES. The comparison results demonstrated a high correlation. Furthermore, we evaluated clinical utility of our panel in 46 glioma patients to assess the detection capacity of potential actionable mutations. Thirty-two patients harbored at least one recurrent somatic mutation in clinically actionable gene. Conclusion We have established a glioma-specific cancer panel. GliomaSCAN highly excelled in capturing somatic variations in terms of both sensitivity and specificity and provided potential clinical implication in facilitating genome-based clinical trials. Our results could provide conceptual advance towards improving the response of genomically guided molecularly targeted therapy in glioma patients.