Fractures involving joints and about the joints provide complex problems with small comminuted fractures, surrounding soft tissue injuries and articular cartilage damage. Various problems are also encountered on the weight bearing surface, especially on the convex side of the distal Femur. Even though many auther had recommended kinds of management upto now, operative methods are more suggested in order to get good results regarding with the accurate anatomical reduction, rigid internal fixation and early joint motion. The clinical analysis of rnanagements of 20 cases of distai femoral fracture demonstrate that seperate dual incision-bilateral or right angle plane-to originate fracture site, and anatomical reduction & rigid internal fixation, early non-weight bearing ROM exercise of joint were sometimes mandatory to treat the displaced, comminuted fracture.
Cartilage, Articular ; Femoral Fractures ; Femur ; Fractures, Comminuted ; Joints ; Soft Tissue Injuries ; Weight-Bearing

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

BACKGROUND: Vitiligo, the pigmentary disorder of the skin and hair, affects patients of various ages from neonates to old adults. According to the onset age, vitiligo is classified as adult or childhood type. Previous clinical studies on childhood vitiligo are rare in Korea. OBJECTIVE: Our purpose was to evaluate the clinical characteristics of childhood vitiligo. METHOD: A clinical investigation was made of 381 outpatients with childhood vitiligo (between 6months and 15years of onset) who had visited the Department of Dermatology, Pusan National University Hospital from January 1988 till December 1997. Results : The results a summarized as follows 1. The subjects consisted of 206(54.1%) females and 175(45.9%) males. 2. The mean age of onset was 7.7 years(males : 8.0, female 7.5). 3. The mean duration of the disease was 2.6 years(male : 2.5, female : 2.7). 4. Familial history was obtained in 30 cases(7.9%) and the most common precipitating factor was trauma(40.0%). 5. Both vulgaris(43.3%) and segmental type(30.4%) were common clinical types in the classification of Ortone et at. Trigeminal distribution(53.4%) was the most common segmental types in Koga's classification. 6. The most common site of initial involvement was the face and neck(52.2%) 7. The most common degree of depigmented lesion was within 5%(84.5%). 8. The progression of vitiligo was present in 68.2% of patients and the incidence of poliosis was 11.5%. 9. Koebner phenomenon was present in 12 cases(3.1%). 10. The most common associated diseases were acne and halo nevus (18.0%). Conclusion : Childhood vitiligo is relatively unique in the clinical findings such as the clinical type(high incidence of segmental type), precipitating factor(trauma is the main factor), depigmented area(small involvement in the extent of the lesion) and the progression of the disease.
Acne Vulgaris ; Adult ; Age of Onset ; Busan ; Classification ; Dermatology ; Female ; Hair ; Humans ; Incidence ; Infant, Newborn ; Korea ; Male ; Nevus, Halo ; Outpatients ; Precipitating Factors ; Skin ; Vitiligo*

The fallowing study was performed in 100 patients undergoing gynecologic lower abdominal surgery. Analgesic efficacy, changes in arterial blood pressure and heart rate, and incidence of side effect were observed after epidural injection of the drugs. The patients were devided into two groups (N=50). Group I was given a bolus dose of 1 mg morphine in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of morphine 0.05 mg/ml in 0.15% bupivacaine at 2 ml/hr. Group II was given a bolus dose of 100 ug fentanyl in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of fentanyl 5 ug/ml in 0.15% bupivacaine at 2 ml/hr. The results were as follows. 1) The pain score (visual analogue pain scale) measured at postoperation 1 hr was significantly decreased in Group II (1.51+/-1.0) compared to group I (2.20+/-1.1). Percentage of patients needed supplemental analgesics within postoperation 20 min was significantly lower in Group II (4%) than Group I (16%). 2) The cardiovascular changes for 2 hrs after epidutal injection were not occurred significant in both groups. 3) The incidence of nausea or vomiting was significantly lower in Group II (8%) than Group I (28%). Pruritus occurred also significantly less often in Group lI (6%) than group I (30%). Urinary retention and respiratory depression were not observed.
Analgesia, Epidural ; Analgesics ; Arterial Pressure ; Bupivacaine ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Injections, Epidural ; Morphine ; Nausea ; Pain, Postoperative* ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

The purpose of this study is to investigate the response of human pulp cell on Portland cement mixed with beta-glycerophosphate. To investigate the effect of beta-glycerophosphate and/or dexamethasone on human pulp cell, ALP activity on various concentration of beta-glycerophosphate and dexamethasone was measured and mineral nodule of human pulp cell was stained with Alizarin red S. MTS assay and ALP activity of human pulp cell on Portland cement mixed with various concentration of beta-glycerophosphate (10 mM, 100mM, 1M) was measured and the specimens were examined under SEM. Addition of beta-glycerophosphate or dexamethasone alone had no effect however, the addition of 5 mM beta-glycerophosphate and 100 nM dexamethasone had the largest increasement in ALP activity. There was no toxicity in all samples and the data showed that Portland cement mixed with 10 mM beta-glycerophosphate had more increase in ALP activity compared with control. In conclusion, Portland cement mixed with beta-glycerophosphate has no toxicity and promotes differentiation and mineralization of pulp cell compared with additive-free Portland cement. This implicated that application of Portland cement mixed with beta-glycerophosphate might form more reparative dentin and in turn it would bring direct pulp capping to success.
Anthraquinones ; Dental Pulp Capping ; Dentin ; Dexamethasone ; Glycerophosphates ; Humans

Opsoclonus is the involuntary, repetitive, rapid conjugate ocular movements occurring in all directions that are irregular in amplitude and frequency. The cause of opsoclonus are idiopathic, paraneoplastic or postinfectious. Opsoclonus of the postinfectious origin often accompanies other abnormal movements such as tremor, myoclonus and ataxia, and shows a relatively benign course with good response to steroid. Six patients who suffered from myalgia, chilling, fever, cough and generalized weakness fior one to two weeks prior to the admission, experienced visual disturbance, gait unsteadiness and clumsiness of the upper extremities,, Prominent opsoclonus, tremulous movements of trunk and limbs, and intermittent myoclonus were observed. These symptoms markedly improved several days following the use of ACTH or dexametasone.
Adrenocorticotropic Hormone ; Adult* ; Ataxia ; Cough ; Dyskinesias ; Extremities ; Fever ; Gait ; Humans ; Myalgia ; Myoclonus ; Ocular Motility Disorders* ; Tremor ; Upper Extremity

Opsoclonus is the involuntary, repetitive, rapid conjugate ocular movements occurring in all directions that are irregular in amplitude and frequency. The cause of opsoclonus are idiopathic, paraneoplastic or postinfectious. Opsoclonus of the postinfectious origin often accompanies other abnormal movements such as tremor, myoclonus and ataxia, and shows a relatively benign course with good response to steroid. Six patients who suffered from myalgia, chilling, fever, cough and generalized weakness fior one to two weeks prior to the admission, experienced visual disturbance, gait unsteadiness and clumsiness of the upper extremities,, Prominent opsoclonus, tremulous movements of trunk and limbs, and intermittent myoclonus were observed. These symptoms markedly improved several days following the use of ACTH or dexametasone.
Adrenocorticotropic Hormone ; Adult* ; Ataxia ; Cough ; Dyskinesias ; Extremities ; Fever ; Gait ; Humans ; Myalgia ; Myoclonus ; Ocular Motility Disorders* ; Tremor ; Upper Extremity

Primary pulmonary meningioma is an extremely rare disease. It is mostly benign and asymptomatic. This tumor shows the same cytohigstologic appearance as brain or spinal cord meninioma. It can be diagnosed as a primary pulmonary meningioma only if there is no evidence of metastasis from the brain or spinal cord meningioma. We experienced a case of primary pulmonary meningioma in a 60-year-old woman who had asymptomatic 2 cm-sized solitary pulmonary tumor in the right lower lobe. It is rather peripherally located. Fine needle aspiration cytology has suggested the possibility of either well-differentiated epithelial malignancy such as papillary adenocarcinoma or mucoepidermoid carcinoma or metastatic carcinoma such as from ductal carcinoma of the breast. Right lower lobectomy was performed. The tumor was bilobated and soild with yellowish color. pathologically it proved to be a primary pulmonary and solid with yellowish color. Pathologically it proved to be a primary pulmonary meningioma because there was no evidance of brain or spinal cord tumor. To the best of our knowledge this is the first case reported in Korea. We report this case with review of the literature.
Adenocarcinoma, Papillary ; Biopsy, Fine-Needle ; Brain ; Breast ; Carcinoma, Ductal ; Carcinoma, Mucoepidermoid ; Female ; Humans ; Korea ; Meningioma* ; Middle Aged ; Neoplasm Metastasis ; Rare Diseases ; Spinal Cord ; Spinal Cord Neoplasms

Background: The efficacy of far-infrared radiation (FIR) after rotator cuff repair has not been demonstrated yet. The aim of this study was to evaluate the effects of postoperatively applied FIR with regard to early pain, range of motion (ROM), and tendon-tobone healing after arthroscopic rotator cuff repair. Methods: A total of 64 consecutive patients who underwent arthroscopic rotator cuff repair with small- to medium-sized tears were enrolled in this prospective comparative study and randomly divided into an FIR group (n = 31) and a control group (n = 33).In the FIR group, FIR using a radiator device (Aladdin-H) was applied for 30 minutes per session twice daily from the first postoperative day. This application lasted for 10 weeks during the postoperative period. Clinical outcomes were assessed using a visual analog scale for pain (pVAS) at 5 weeks and ROM at 3 and 6 months postoperatively. Functional scores were evaluated at 6 months postoperatively. Healing of the repaired rotator cuff was also evaluated using ultrasonography at 3 months and magnetic resonance imaging at 6 months postoperatively. Results: In both groups, clinical and functional outcomes were improved up to 6 months compared with preoperative values. At 5 weeks and 3 months postoperatively, the average pVAS was significantly lower in the FIR group than in the control group (1.7 ± 1.0 vs. 2.8 ± 1.4; p = 0.002 at 5 weeks, 2.4 ± 1.3 vs. 3.2 ± 1.8; p = 0.041 at 3 months). However, there was no significant difference in ROM, functional score, or healing rate between two groups at each follow-up time point. Conclusions The application of FIR after arthroscopic rotator cuff repair could be a safe and effective procedure to decrease postoperative pain, especially in the early postoperative period. This effective application of FIR can be considered to facilitate painless rehabilitation in the postoperative period after arthroscopic rotator cuff repair.

We investigated the postictal EEG and semiology in temporal lobe epilepsy in order to evaluate their possible clinical utility. Fifty four well lateralized seizures in 10 patients, recorded during presurgical evaluation, were analysed in regard to the frequency, pattern and location of the EEG activity (42 seizures with scalp-sphenoidal electrodes, 27 seizures with intracranial electrodes). Postictal EEG changes were very heterogenous, at best categorized to several patterns: (1) theta+delta slowing (2) attenuation (3) spike activation, among them theta+delta slowing was mosts frequently encountered. The lateralizing value of the earliest pattern was 59.3% using intracranial electrodes but only 23.3% using scalp-sphenoidal electrodes. Postictal semiology also showed a variety of behavioral manifestation such as confusion(81.5%), lip smacking(40.7%), hand automatism (18.5%). Lip smacking was more often seen following the left temporal seizure (16 out of 22, p<.05). Behavioral distinction between ictal and postictal semiology was not possible. Postictal EEG and semiology appears to be consisting of heterogenous mechanisms and wide spectrum. We feel that the clinical utility is limited.
Automatism ; Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Hand ; Humans ; Lip ; Seizures ; Temporal Lobe*