No abstract available.
Endometriosis* ; Female

Fracture and fracture-dislocation of the ankle may be caused by a variety of mechanisms. In addition to the fracture, injury of soft tissue such as ligaments, tendons, nerves, and muscles may occur. Among these, tibialis posterior tendon injury is difficult to identify due to swelling and pain at the fracture site. There is no clear finding in radiological examination, therefore, it is found during surgery. In this case, irreducible fracture-dislocation of the ankle due to tibialis posterior tendon interposition was observed after the primary operation. The authors obtained satisfactory results in performance of a secondary operation assisted with arthroscopy.
Ankle Fractures ; Ankle* ; Arthroscopy ; Ligaments ; Muscles ; Tendon Injuries ; Tendons*

OBJECTIVE: Intracavitary injection of beta-emitting radiation source for control of cystic tumors has been tried with a benefit of localized internal radiation. The authors treated cystic brain tumor patients with Holmium-166-chitosan complex (Ho-166-chico), composed of a beta-emitting radionuclide Holmium-166 and biodegradable chit polymer, and evaluated the safety and effective measurement for response. METHODS: Twenty-two patients with recurrent cystic brain tumor and/or located in a deep or eloquent area were enrolled in this pilot study. The cyst volume and wall thickness were determined on CT or MRI to assess radiological response. The activity of Ho-166-chico injected via Ommaya reservoir was prescribed to be 10-25 Gy to the cyst wall in a depth of 4 mm. RESULTS: There was neither complications related to systemic absorption nor leakage of Ho-166-chico in all 22 patients. But, two cases of oculomotor paresis were observed in patients with recurrent craniopharyngioma. Radiological response was seen in 14 of 20 available follow-up images (70%). Seven patients of 'evident' radiological response experienced more than 25% decrease of both cyst volume and wall thickness. Another 7 patients with 'suggestive' response showed decrease of cyst volume without definitive change of the wall thickness or vice versa. All patients with benign tumors or low grade gliomas experienced symptomatic improvement. CONCLUSION: Ho-166-chico intracavitary radiation therapy for cystic tumor is a safe method of palliation without serious complications. The determination of both minimal effective dosage and time interval of repeated injection through phase 1 trial could improve the results in the future.
Absorption ; Brain Neoplasms* ; Brain* ; Chitosan ; Craniopharyngioma ; Follow-Up Studies ; Glioma ; Holmium ; Humans ; Paresis ; Pilot Projects* ; Polymers

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by elevated parathyroid hormone levels. In most cases, the disease involves a single parathyroid adenoma, followed by parathyroid hyperplasia, but the incidence of ectopic parathyroid adenoma is rare. However, in cases where the parathyroid hormone level remains high even after parathyroid surgery, an ectopic parathyroid gland should be considered. Here in a case of a 60-year-old female who presented PHPT is reported. She had undergone a surgical removal of the parathyroid gland of suspected hyperplasia, but still represented persistent PHPT, postoperatively. Ectopic mediastinal parathyroid adenoma was identified by 99mTc-sestamibi parathyroid scan and surgical excision via a median sternotomy approach was performed. Thirty-eight months postoperatively, there was no evidence of recurrence. Preoperative localization assessment is critical for minimizing surgical failure in cases of PHPT.

BACKGROUND: The laryngeal mask airway (LMA) is relatively easy to use and may have advantages over an endotracheal tube (ETT). This randomized cross over study was performed to compare the respiratory parameters of a LMA and ETT in anesthetized mechanically ventilated patients. METHODS: Thirty ASA physical status I and II adult patients undergoing peripheral limb surgery were studied. Anesthesia was induced with fentanyl 1.5ng/kg and thiopental sodium 5 mg/kg. Anesthesia was maintained with O2 1 L/min - N2O 1 L/min - enflurane (end tidal concentration 1.0 1.5 vol%) and muscle relaxation was accomplished using vecuronium 0.12 mg/kg. A LMA and ETT were placed in a random sequence in each patient and connected to a ventilator. After 15 minutes of each insertion at the same ventilator setting, ventilatory variables and arterial CO2 partial pressure were measured and physiological dead space/tidal volume ratio was calculated by a CO2SMO plus! respiratory profile monitor. RESULTS: Physiological dead space/tidal volume ratio and airway dead space in the LMA group were significantly higher compared with those in the ETT group. There were no statistically significant differences in dynamic and static compliance. Inspiratory and expiratory airway resistance were lower in the LMA group. There were no significant differences in air leakage fraction and total inspiratory work done by the ventilator on the respiratory system. Airway pressure, arterial, end-tidal and mixed expired CO2 partial pressure were similar in both groups. CONCLUSIONS: Efficiency of ventilation is similar with a LMA and ETT during positive ventilation in patients without pulmonary disease. We found no differences of clinical importance in either group of patients in the range of measured parameters.
Adult ; Airway Resistance ; Anesthesia ; Arterial Pressure ; Compliance ; Enflurane ; Extremities ; Fentanyl ; Humans ; Laryngeal Masks* ; Lung Diseases ; Muscle Relaxation ; Partial Pressure ; Positive-Pressure Respiration* ; Respiratory Mechanics* ; Respiratory System ; Thiopental ; Vecuronium Bromide ; Ventilation ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Papillary thyroid carcinoma (PTC) frequently occurs as multifocal and bilateral tumors. However, multifocality and bilaterality are not easy to detect preoperatively and contralateral remnant tumor might lead to reoperation after hemithyroidectomy. We aimed to demonstrate the frequency of bilaterality and predictive factors for occult contralateral PTC when a frozen biopsy of hemithyroidectomy shows multifocal PTCs in one of the lobes. SUBJECTS AND METHOD: One hundred and thirty patients with PTC were enrolled in this study. All patients underwent hemithyroidectomy and frozen biopsy, followed by total thyroidectomy because of ipsilateral multifocality. Medical records, pathologic results, and preoperative ultrasound results were reviewed retrospectively. Patients were divided into two groups depending on bilaterality (unilateral or bilateral). RESULTS: Bilaterality was detected in 74 of 130 patients (56.9%). Bilateral group showed more number of carcinomas (3.9±1.4 vs. 2.3±0.9) and more tendency of existence of contralateral nodule (87.8% vs. 55.3%). Tumor size of 1 cm or more and contralateral nodules were significant predictive factors for the existence of occult contralateral PTC. The suspicious sonographic feature of contralateral nodule had 75.7% sensitivity and 75% specificity for detecting bilaterality. CONCLUSION: The incidence of bilateral PTC is high in patients with ipsilateral multiple tumors. When the frozen biopsy result shows multifocality in one of the lobes, the remnant tumor may lead to reoperation under recent guidelines on thyroid surgical extent. Characteristics of contralateral nodule can help physicians and patients to make the decision regarding surgical extent.
Biopsy* ; Frozen Sections ; Humans ; Incidence ; Medical Records ; Methods ; Reoperation ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

PURPOSE: We wanted to compare the results between cadaveric and radiological measurements of calcaneus. MATERIALS AND METHODS: Sixty three calcaneus of 33 cadavers donated between December 2012 and December 2014 were actually measured. Computed tomography (CT) images of 244 calcaneus in 122 patients of the same age group with cadavers were radiologically measured. Maximum length, maximum width, maximum height, Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were measured. RESULTS: In cadaveric measurement, the mean maximal height, length, and width were 41.8+/-3.3 mm, 73.3+/-3.4 mm, and 40.7+/-2.2 mm, respectively. In radiological measurement, the mean maximal height, length, and width were 38.5+/-4.3 mm, 74.0+/-5.7 mm, and 44.7+/-1.4 mm, respectively. In cadaveric measurement, the mean Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were 32.1degrees+/-6.2degrees, 110.8degrees+/-8.1degrees, 55.8degrees+/-6.8degrees, and 59.7degrees+/-4.6degrees, respectively. In radiological measurement the mean Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were 32.6degrees+/-3.8degrees, 113.7degrees+/-5.7degrees, 62.2degrees+/-3.9degrees, and 61.6degrees+/-6.3degrees, respectively. The mean maximal height was significantly higher in the cadaveric measurement group (p<0.001) and the mean maximal length and width were significantly higher in the radiologic measurement group (p<0.001, p<0.001). The mean Gissane angle, Fowler-Philip angle, and Bohler angle were significantly higher in the CT group (p=0.001, p<0.001, p=0.016, respectively). There was no significant difference in the mean tala-articular angle (p=0.352). CONCLUSION: Significant differences in length parameters were observed between the cadaveric measurement group and the radiologic measurement group. However, no significant differences in angular measurements were observed between the two groups. The authors carefully conclude that radiological measurement values may be different from actual values in the calcaneus.
Cadaver* ; Calcaneus* ; Humans

OBJECTIVE: Atypical and malignant meningiomas(AM, MM) are known to be rare and show aggressive behavior. Limited data are available concerning the clinical features, effectiveness of surgical removal and role of radiation therapy with AM, MM. The authors report our experience of AM, MM, with respect to clinical features. METHODS: Twenty-four cases of AM and 28 cases of MM, who were operated between 1988 and 1999 were retro-spectively studied review of medical records and radiological findings. These were compared with control group of 24 cases of menigiomas manifestating usual clinical course, which are selected arbitrarily among operative cases between Apr. 1999 and Dec. 1999. Mean follow-up periods were 26(1-91) months for AM and 23(1-62) for MM. Authors analyzed the prognostic factors for survival, and statistical analysis were accomplished by Kaplan-Meier method and log-rank test. RESULTS: Differences of clinical features between control groups and these atypical and malignant meningioma group were not significant. However, the location of MM was frequent in non-basal area(p<0.01). In AM, there were 4 patients of recurrence, and 3 patients of mortality. Among mortality cases, only one patient died of tumor progression, the other patients died of other causes. The survival at 2 year and 5 year in this group were 88% and 74% respectively, and in MM, 11 patients died due to tumor progression and 2 had spinal metastasis. The survival at 2 year and 5 year were 72% and 20%, respectively. For extent of resection, total removal(Simpson grade 1 or 2) was less often achieved in MM compared with AM(50% vs. 83%). Extent of resection of tumor and postoperative radiation therapy did not affect survival in both AM, MM. CONCLUSIONS: Clinical behavior of AM showed more benign than that of MM. Prognostic factor for survival is not related extent of resection of tumor and postoperative radiation therapy. However, further investigation with long-term follow-up and additional cases is mandatory.
Follow-Up Studies ; Humans ; Medical Records ; Meningioma* ; Mortality ; Neoplasm Metastasis ; Recurrence

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.
Adult ; Ankle Joint ; Ankle ; Humans ; Knee ; Lipoma ; Lipomatosis ; Magnetic Resonance Imaging ; Synovial Membrane ; Tendons

PURPOSE: To evaluate the patterns and the treatment of instability after primary TKA. MATERIAL & METHOD: We studied 8 patients (9 cases) who had instability after TKA. We analyze the onset of symptom, patterns and main causes of instability, method of treatment, and results. The average follow-up period was 31 months. RESULT: Average onset of symptom after TKA was 10.1 month (8 day -4 years 4 month). The patterns of instability included anterior/posterior instability in 2, valgus/varus instability in 5 and global instability in 2. The treatments were thicker polyethylene exchange in 1, repair or reconstruction of collateral ligament with polyethylene exchange in 5, and revision with constrained or hinged implant in 3 when it was impossible to correct the imbalance of flexion-extension gap. All patients got stable knees and KSS functional and knee scores improved from average 55 and 56 points to 88.8 and 91 points respectively. CONCLUSION: Active repair or reconstruction of the ligament with polyethylene exchange wasone of the good options for treating instability after TKA. In cases of severe instability that could not be corrected by polyethylene exchange and repair or reconstruction of the ligament, revision with constrained or hinged implant was necessary.
Arthroplasty* ; Collateral Ligaments ; Follow-Up Studies ; Humans ; Knee* ; Ligaments ; Polyethylene