In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.
Cholangiography ; Choledochal Cyst ; Duodenum ; Preschool Child

The role of the long head of biceps brachii tendon in the stahilization of the head of the humerus is a highly interesting issue in recent studies. But, it is not well understood. Congenital absence of biceps long head tendon ot the hilateral shoulder joint is very rare and on review of literatures, we could not find any case reported. We experienced one case which was confirmed by magnetic resonance imaging and arthroscopic examination of the shoulder, and report it with review of literatures.
Head* ; Humerus ; Magnetic Resonance Imaging ; Shoulder Joint* ; Shoulder* ; Tendons*

Total knee arthroplaty has been used to treat the elderly patient who has severe arthritis but the early designs were associated with many problems, which frequently led to early failure. In 1974, the total knee arthroplasty was introduced and the reported results of this operation have improved consistantly with time. Recently the good results has been shown to treat rheumatoid patients and osteoarthritis patients less than 45 years old patients. At the department of orthopaedic surgery of Kosin Medical College, between 1984 and 1988, total knee arthroplasty was performed in 17 patients (22 kness) who had rhematioid arthritis (7 patients) and osteoarthritis (11 patients), and had followed for an average of 1 year and 8 months. The results were as follows 1. The knee that had rheumatoid arthritis had better knee scores than that of osteoarthritis. 2. The knee that remained the post cruciate lig. had better range of motion than that sacrificed. 3. The knees that had not used cement had better knee scores than that had used the cement. 4. The knees that had patella resulrfacing had better scores for pain than that had not.
Aged ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Humans ; Knee ; Osteoarthritis ; Patella ; Range of Motion, Articular

An axial-pattern flap can be transferred as the free-flap and has many merits over a random-pattern local flap. However, this has limitations of available vascular architecture and donor site. To overcome these problems, many types of prefabricated flaps have been designed using vascular bundles. It is possible to convert a random-pattern flap to a neovascularized axial-pattern flap by transferring a vascular pedicle. In an attempt to study the effects of prefabrication using vascular bundles, the survival rate between random-pattern flap and prefabricated axial-pattern flap was compared in this study. The rabbits were divided into two groups. The control group was consisted of the random-pattern flap and the prefabricated group was consisted of the prefabricated axial-pattern flap using femoral vascular pericles of rabbits. Femoral vascular pedicles were transferred under the 5x5cm lower abdominal flaps without any perivascular tissue. Three weeks later, random-pattern flaps were elevated without any axial vascular pedicle and prefabricated flaps were elevated based on the transferred femoral vascular pericles. The survival rate of the flaps in the control group and experimental group was 67.37% and 98.87% respectively. Based on the result of t-test there was significant difference between two groups. According to these results, it is concluded that prefabricated flap using transferred vascular pedicle was more effective than random-pattern flap. We think that this technique is versatile for wound repair and for use in other aspects of plastic and reconstructive surgery.
Humans ; Plastics ; Rabbits* ; Survival Rate ; Tissue Donors ; Wounds and Injuries

Colloidal gold 198Au were injected into 40 knee joints of rabbits for the study of the change of synovial membrane. We verified even distribution of Colloidal gold 198Au about knee joints by use of scintigraphy. After then, histopathological examinations were performed by periodic intervals. The following results are obtained form this study. l. Intra-articular injection of Colloidal gold 198Au into rabbit's knee joints resulted in a mild resctive inflammation at synovium. In was charscterized by an infiltration of eosinophils and by sclerotic changes in the subsynovium and by fibrosis of synovial vessels. 2. From this study, intra-articular injection of Colloidal gold 198Au may by benefit to treat the chronic synovial effusion in human.
Colloids ; Eosinophils ; Fibrosis ; Gold Colloid ; Humans ; Inflammation ; Injections, Intra-Articular ; Knee Joint ; Rabbits ; Radionuclide Imaging ; Synovial Membrane

In fusion of lumbar spine, every fused motion segments shows varisble limitation of motion in flexion, extension and lateral bending according to their types and level of fusion. The motion segment of lumbar spine is three joint complex which consists of posterior two articular facet joints and an anterior intervertebral disc. Nowadays, orthopedic surgeon prefer anterior fusion due to direct identification and removal of diseased tissue, reduction of fractured fragments, restoration of intrevertebral space, early rehabilitation and no damage of nerve root and cord, and is prefered short Segmental Spinal Instrumentation(e.g. Cotrel Dubousset Instrumentation, etc.) due to short and rigid fusion, no necessity of external support and low limitation of motion. We studied 58 cases of fused lumbar spine which had been operated since Sep.1983, by X-ray overlay method and 20 cases of healthy lumbar spine as eontrol group. In this study, we obtained following results ; 1. Harrington Rod Instrumentation reveals the most remarkable limitation of motion, whereas, C.D.I. and A.I.F. reveal the least limitation of motion. 2. Distinct differencies of motion are repersented by its range of fusion and range of motion in 2 segmental fusion reveals remarkable decreasement from range of motion in single segmental fusion. 3. In single segmental fusion, the most limitation of motion was represented in Harrington Rod Instrumentation and posterior fusion with bone graft. There is remarkable decreasement of flexion at lumbosacral junction by its site of fusion. 4.In double segmental fusion, the most limitation of motion was represented in Harrington Rod Instrumentation and there is no significant difference of motion by its site of fusion.
Intervertebral Disc ; Joints ; Methods ; Orthopedics ; Range of Motion, Articular ; Rehabilitation ; Spine ; Transplants ; Zygapophyseal Joint

Aspergillus tracheobronchitis, an uncommon form of invasive pulmonary aspergillosis, is characterized by the development of a pseudomembrane, ulcers, or an obstruction that is predominantly confined to the tracheobronchial tree. Pseudomembranous Aspergillus tracheobronchitis is the most severe form of Aspergillus tracheobronchitis, and only a few cases have been reported in Korea. We report the characteristic chest CT findings in a patient diagnosed with pseudomembranous Aspergillus tracheobronchitis after bronchoscopy and successfully treated by proper antifungal treatment.

Although a variety of methods were employed for the coverage of heel defects, reconstruction of large soft tissue defects of the heel is not a simple task. Recently, free muscle flaps are frequently employed for heel reconstruction. Several muscles, such as latissimus dorsi, rectus abdominis, or gracilis muscle have been used for the reconstruction of large heel defects. Since 1994, 6 cases of large heel defects were reconstructed using free gracilis flaps with split-thickness skin grafts, and the results were successful. This method is suitable for moderate to large size heel defects, except for the extensive complex defects beyond the heel territory. The major advantages are (1) relatively simple free flap (2) the volume of the muscle, after denervation atrophy, is so completely fit for the heel defect that special shoe is seldom necessary (3) donor defect is minimal, aesthetically and functionally (4) long gracilis muscle with proximal pedicle provides flexibility of shaping the heel (5) the capacity to withstand shear-force is much better than that of musculocutaneous flaps. All flaps survived completely and the results were successful. Our experiences, operative procedures and the results of maximum two rears of follow-up are presented with our descriptive method for heel defects.
Atrophy ; Denervation ; Follow-Up Studies ; Free Tissue Flaps ; Heel* ; Humans ; Muscles ; Myocutaneous Flap ; Pliability ; Rectus Abdominis ; Shoes ; Skin ; Superficial Back Muscles ; Surgical Procedures, Operative ; Tissue Donors ; Transplants

PURPOSE: For choledocholithiasis, many doctors routinely use ERCP/EST to avoid the need for common bile duct exploration. But, ERCP/EST has some weakpoints. So it may not be a first choice for management, especially in secondary hospitals. Therefore, we investigated and reviewed results of LCBDE as a first treatment for common bile duct stones. METHODS: This study was a retrospective analysis of 60 cases that could be reviewed by their medical charts and who underwent LCBDE performed by the same surgeon at the Yeosu Chonnam Hospital between March, 1996 and August, 2009. The clinical data were compared between each two groups (1996~1999 vs 2000~2009 years, primary closure vs T tube drainage). RESULTS: Between groups A and B, there were no significant differences in preoperative status of the patient except for age (60.5 vs 72.6). The average operative time was decreased in group B (171.6 mins vs 143.0 mins) and the number of trocars was decreased in group B (4 vs 3.2). There were 13 postoperative complications. Among them, 11 were cases of bile leakage. All of the bile leakage cases were in group B. And there were more bile leakages in the primary repair group than in T tube drainage group (50% vs 8.9%). But, 10 cases of bile leakage were improved completely by observation and conservative treatment. CONCLUSION: LCBDE is a safe and useful treatment that has several advantages and can overcome problems not solved by ERCP. Fatal complications were not increased in the primary repair group compared with the T tube drainage group.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Drainage ; Humans ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments

Herpes simplex esophagitis can occur in those with normal immune function, but is more often seen in those who are immunocompromised. In one series, 5 percent of post-kidney transplant recipients had herpes esophagitis. We experienced a case of herpes simplex esophagitis, following renal transplantation in a 9 year old male. He complained of epigastric pain, nausea and blood-tinged vomiting. Endoscopic examination showed volcano ulcer, mucosal friability and multiple confluent ulcers covered by whitish exudates on elevated margin in the middle and lower esophagus. Microscopic findings revealed multinucleated giant cells, margination of chromatin, intense nonspecific inflammation and strong positive for herpes simplex virus immunohistochemical staining. Esophageal lesions and symptoms improved after acyclovir therapy.
Acyclovir ; Child* ; Chromatin ; Esophagitis ; Esophagus ; Exudates and Transudates ; Giant Cells ; Herpes Simplex* ; Humans ; Inflammation ; Kidney Transplantation ; Male ; Nausea ; Simplexvirus* ; Transplantation ; Ulcer ; Vomiting