PURPOSE: To compare clinical outcomes when using open or arthroscopic release for recalcitrantlateral epicondylitis. MATERIALS AND METHODS: A total of 34 cases were followed up for an average of 16 months. Open release was performed in 21, and arthroscopic release in 13. In the open release group, arthroscopic examination was performed first in 7. Intraarticular and extraarticular lesions of the extensor tendon were compared. Pain was evaluated using the Visual Analog Scale, and function was evaluated using the assessment of Nirschl and Pettrone. RESULTS: In arthroscopic findings, 6 out of 20 cases were nearly normal, 6 showed fraying, 4 a linear tear, and 4 avulsion. Some (3 of 5) cases with nearly normal arthroscopic findings had mucinoid degeneration detected during the open procedure. Overall, 86% of open release and 85% of arthroscopic release showed satisfactory results. CONCLUSION: The extraarticular and intraarticular surfaces of the extensor origin had diverse appearances, and both procedures showed satisfactory results. Therefore, arthroscopic release is a useful treatment option for recalcitrant lateral epicondylitis.
Elbow ; Tendons

PURPOSE: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. MATERIALS AND METHODS: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. RESULTS: The KSS improved from 46.5+/-7.6 to 89.1+/-5.9 points (p<0.001) and the FS increased from 39.5+/-9.2 to 84.2+/-8.5 points (p<0.001). The range of motion increased from 101.5+/-28.2degrees to 116.0+/-10.8degrees (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2+/-5.0degrees to valgus 5.6+/-1.5degrees (p<0.001) and the mechanical axis angle was revised from varus 13.9+/-4.5degrees to varus 0.7+/-1.6degrees (p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0+/-0.6degrees and there was no significant difference between the bony union group and the fibrous union group (p=0.175). CONCLUSION: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.
Arthroplasty ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteotomy ; Range of Motion, Articular

Nerve palsy after total knee arthroplasty is a rare complication and this is usually associated with local nerve compression or severe deformity of the knee. In many cases, the cause of nerve palsy was unknown and this is rarely associated with vascular complication. We report here on a case of the patient who had nerve palsy and delayed arterial occlusion after total knee arthroplasty.
Arthroplasty ; Congenital Abnormalities ; Humans ; Knee ; Paralysis

PURPOSE: To evaluate the clinical relationship between medial collateral ligament(MCL) complete detachment and mechanical alignment in total knee arthroplasty. MATERIALS AND METHODS: From February 2001 to December 2006, we performed 290 TKAs. 9 TKAs(0.03%) happened MCL complete detachment. 1 TKA was excluded for paraplegia. All cases were women. The mean age was 71.1 years old. The mean follow-up period was 41.1 months. There were 7 degenerative osteoarthritis and 1 rheumatoid arthritis. The clinical evaluation included Knee Society Score(KSS), function score and range of motion(ROM) at preoperative, postoperative 3 months, 6 months, 12 months and final follow-up. We measured the femoro-tibial angle and the mecha- nical axis by anterior-posterior and whole lower extremity radiograph. The medial instability obtained serial valgus stress radiograph. RESULTS: There were 4 neutral and 4 varus alignment. KSS, function score, ROM was significantly improved in both group, and there were no significant differences in both group. On serial valgus stress radiograph, the difference compared with normal side decreased from 5.2 degree(postoperative 3 months) to 3.4 degree(final follow-up) in neutral alignment group, from 2.9 degree to 0.9 degree in varus alignment group. In final follow-up, it revealed that the medial instability of varus alignment group was less than that of neutral alignment group. CONCLUSION: In MCL complete detachment, some stability obtained by repair of medial collateral ligament and bracing. Whole instability was not gone. Therefore, we should make the varus alignment of prosthesis in mechanical axis line position of 34 to 67% on the medial tibial plateau.
Arthritis, Rheumatoid ; Arthroplasty ; Axis, Cervical Vertebra ; Braces ; Collateral Ligaments ; Female ; Follow-Up Studies ; Humans ; Knee ; Lower Extremity ; Osteoarthritis ; Paraplegia ; Prostheses and Implants

PURPOSE: The purpose of this study was to describe the MR findings of the spectrum of the Currarino triad and to discuss the potential role of MR imaging in evaluating these anomalies. MATERIALS AND METHODS: Seven children (age range: 2-12 months) with Currarino triad were evaluated using MR imaging, plain radiography, and barium study. In addition, CT scans (n=3) and sonography (n=2) were performed. We retrospectively analyzed MR imaging findings and correlated these with the findings of other imaging modalities. RESULTS: Anorectal anomalies included anorectal stenosis in five patients and an imperforate anus in two. MR imaging findings of anorectal stenosis included an elongated thick-walled anorectal canal and dilatation of the proximal segment of the rectum. In the patients with an imperforate anus, the location of the blind rectal pouch and sphincteric musculature was delineated. In one case, a transcolostomy enema revealed a fistula not evident on MR images. Presacral masses included four teratomas and three lipomas associated with various spinal anomalies. On MR imaging, which gave better results than CT or sonography, a detailed evaluation of presacral masses and associated anomalies was possible. Sacral anomalies included a typical scimitar-shaped sacral defect in five patients, abnormal curvature in one, and malsegmentation in one. In all cases, MR imaging showed the abnormal sacrum, but plain radiography more clearly demonstrated its anomalous shape. CONCLUSION: Various anorectal anomalies, presacral masses, and other associated anomalies were demonstrated by MR imaging. When the Currarino triad is suspected, MR imaging should therefore follow plain radiographs.
Anal Canal ; Anus, Imperforate ; Barium ; Child ; Constriction, Pathologic ; Dilatation ; Enema ; Fistula ; Humans ; Lipoma ; Magnetic Resonance Imaging* ; Radiography ; Rectum ; Retrospective Studies ; Sacrum ; Teratoma ; Tomography, X-Ray Computed

OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

In hydranencephaly, the cerebral hemispheres are absent or represented by membranous sacs with remnants of frontal, temporal or occipital cortex dispersed over the membrane. The brain stem is relatively intact. The cause of hydranencephaly is unknown, but bilateral occlusion of the internal carotid arteries during early fetal development can explain most of the pathologic abnormalities. We evaluated a case of hydranencephaly by magnetic resonance (MR) angiography. MR angiography shows both common, external carotid and vertebrobasilar arteries with no delineation of both internal carotid arteries from their origins. A brief review of the related literature was given on this subject.
Angiography ; Arteries ; Brain Stem ; Carotid Artery, Internal ; Cerebrum ; Fetal Development ; Hydranencephaly ; Magnetic Resonance Angiography* ; Membranes

Alagille syndrome is characterized by chronic cholestasis, posterior embryotoxon, skeletal abnormalities, cardiovascular abnormalities, and a typical face with prominent forehead and pointed chin. Its histological feature includes paucity of interlobular bile ducts. We experienced a 49-day-old female infant presenting with frequent upper respiratory tract infection and persistent jaundice. She had a typical face and chronic cholestasis. Echocardiograms revealed peripheral pulmonary stenosis. The histological examination of liver revealed paucity of interlobular bile ducts.
Alagille Syndrome* ; Cardiovascular Abnormalities ; Chin ; Cholestasis ; Female ; Forehead ; Humans ; Infant ; Jaundice ; Liver ; Pulmonary Valve Stenosis ; Respiratory Tract Infections

BACKGROUND: This study evaluated the preoperative distractive stress radiographs in order to quantify and predict the extent of medial release according to the degree of varus deformity in primary total knee arthroplasty. METHODS: We evaluated 120 varus, osteoarthritic knee joints (75 patients). The association of the angle on the distractive stress radiograph with extent of medial release was analyzed. The extent of medial release was classified into the following 4 groups according to the stage: release of the deep medial collateral ligament (group 1), release of the posterior oblique ligament and/or semimembranous tendon (group 2), release of the posterior capsule (group 3) and release of the superficial medial collateral ligament (group 4). RESULTS: The mean femorotibial angle on the preoperative distractive stress radiograph was valgus 2.4degrees (group 1), valgus 0.8degrees (group 2), varus 2.1degrees (group 3) and varus 2.7degrees (group 4). The extent of medial release increased with increasing degree of varus deformity seen on the preoperative distractive stress radiograph. CONCLUSIONS: The preoperative distractive stress radiograph was useful for predicting the extent of medial release when performing primary total knee arthroplaty.
Aged ; *Arthroplasty, Replacement, Knee/methods ; Female ; Humans ; Joint Deformities, Acquired/etiology/radiography ; Knee Joint/*radiography ; Ligaments, Articular/radiography ; Male ; Medial Collateral Ligament, Knee/*surgery ; Middle Aged ; Osteoarthritis, Knee/complications/radiography/*surgery

PURPOSE: To analyse and interpret different sonographic findings in acute nonperforated and appendicitis. MATERIALS AND METHODS: In 46 cases of acute appendicitis in children(26 girls, 20 boys) proven by surgery, sonographic findings were reviewed retrospectively. The findings of nonperforated and perforated appendicitis were analysed, focusing on the size, shape and echogenicity of the appendix, echo patterns of periappendiceal abscesses, mesenteric lymphadenopathy, and the prevalence of appendicolith. RESULTS: A noncompressible distended appendix was present in 18 of 21 patients with nonperforated appendicitis and in 13 of 25 patients with perforation. In 18 patients with nonperforated appendicitis, the average diameter of distended appendix was 8.6mm;target appearance was noted in 16 patients and loss of echogenic submucosa in two. In 13 patients with perforated appendicitis, the average diameter of appendix was 9.1 mm;target appearance was noted in four patientsand loss of echogenic submucosa in nine. periappendiceal abscesses were present in 21 of 25 cases of perforated appendicitis, and the echogenicity of abscesses was mixed in 12 patients, hypoechogenic in eight, and hyperechogenic in one. Mesenteric lymphadenopathy was present in two of 21 patients with nonperforated appendicitis and in four of 25 with perforation. Appendicolith was detected on sonography in three of 25 patients with perforated appendicitis, but was found in seven patients during surgery. One patients with perforated appendicitis also had right side hydronephrosis. Sonographically false-negative results were obtained in sixcases. CONCLUSION: A sonographic examination was useful to differenciate perforated and nonperforated appendicitis in children. Loss of echogenic submucosa in the distended appendix and periappendiceal abscess formation were important findings in diagnosis of perforated appendicitis.
Abscess ; Appendicitis* ; Appendix ; Child* ; Diagnosis ; Female ; Humans ; Hydronephrosis ; Lymphatic Diseases ; Prevalence ; Retrospective Studies ; Ultrasonography