The purpose of this paper is to compare the results, complications, advantages and disadvantages of treatment by flexible intramedullary nail with those by interlocked intramedullary nail in humeral shaft fractures. The authors analyzed 42 cases of humeral shaft fractures in patients who were treated by intramedullary nailing. Nineteen patients were treated with flexible I-M nail and twenty three patients were treated with interlocked I-M nail. Fourteen cases(74%) treated with flexible I-M nail were obtained primary bone union, and twenty one cases(91%) treated with interlocked I-M nail were obtained primary bone union. Five cases treated with flexible I-M nail and 2 cases treated with interlocked I-M nail failed union and the most common cause of nonunion was distraction. Flexible I-M nailing does not solve rotational deformity and could't obtain a high union rate due to distraction. Therefore, we recommend that adequate external support is considered to prevent distraction using the flexible I-M nail. Although we obtained a satisfactory union rate using by Seidel interlocked I-M nail, we must observe the distal spreading screw loosening during the follow up period. In bones with small diameter, sufficient reaming may be necessary, because the distal spreading screw can't spread well.
Congenital Abnormalities ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans

No abstract available.
Pulmonary Atelectasis*

No abstract available.

BACKGROUND: The sources of pulmonary blood flow in patients with pulmonary atresia and ventricular septal defect (PA/VSD) are very diverse, and detailed informations for the pulmonary circulation are essential for successful treatment. The purpose of this study is to examine and define the origins, distributions and characteristics of collateral circulations in patients with PA/VSD and major aortopulmonary collateral arteries (MAPCAs). METHODS: 34 patients diagnosed as PA/VSD and MAPCA were studied between May 1992 and April 1996. 85 MAPCAs were investigated for the sites of origin, distributions and characteristics by review of biplane angiograms. The characteristics of MAPCAs were examined in the aspects of anastomosis sites and sites/types of stenosis. RESULTS: 1) In 34 subjects, a total of 85 MAPCAs existed which supplied blood to 344 bronchopulmonary segments (4.1 BPS/MAPCA). 2) The origin sites of MAPCAs were the descending aorta (72%), the branch of aortic arch (16%), and the aortic arch or ascending aorta (12%). 3) The BPSs which frequently take primary blood supply from MAPCA were the 3 BPSs of upper lobe and superior / posterior basal segment of lower lobe in the right lung, and the superior / posterior basal segment of lower lobe in the left lung. 4) The BPS having apparent dual blood supply was 13.4% and the most frequent was the superior and posterior basal segment of the right lower lobe. 5) In total, 64% of MAPCA had anastomosis, and anastomosis in the lobar pulmonary artery was 48% to be the most frequent. 6) Stenosis was observed in 61% of MAPCAs. The site of stenosis was midportion (33%), originating portion (27%), multiple (26%), peripheral (14%), and the type of stenosis was focal (53%), segmental (31%), diffuse (16%), in the order of frequency. CONCLUSION: In PA/VSD and MAPCA, selective angiogram should be performed in all the different blood-supplying sources of the lung for detailed information of the pulmonary circulation. When the blood sources of the pulmonary circulation is uncertain, elaborated efforts to find the blood sources, by angiograms in the frequent locations of MAPCA, are neccessary. We believe this study to be useful for precise planning in the diagnosis and treatment of PA/VSD and MAPCA.
Angiography ; Aorta ; Aorta, Thoracic ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Diagnosis ; Heart Septal Defects, Ventricular* ; Humans ; Lung ; Pulmonary Artery ; Pulmonary Atresia* ; Pulmonary Circulation

PURPOSE: To compare, through enalysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrone between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. MATERIALS AND METHODS: The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD group (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex, and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. RESULTS: The mean CAC score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.006). The mean CAC score at the sixth decade was also significantly different between group I (81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC+1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly higher than in groups I and II. Multiple regression analysis showed that the CAC score was related to age, diabetes mellitus and hypertension in group I, diabetes mellitus only in group II, but no particular factor in group III. CONCLUSION: The CAC score of the acute coronary syndrome group tended to be lower than that of the chronic CAOD group. It appears to be difficult to predict acute coronary syndrome on the basis of CAC alone. Compared with the asymptomatic high-risk group of atherosclerosis patients, the acute coronary syndrome group, whose members are younger and have a higher incidence of smoking, has a relatively high CAC score.
Acute Coronary Syndrome ; Atherosclerosis* ; Calcium* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Obesity ; Risk Factors ; Smoke ; Smoking ; Tomography, X-Ray Computed*

A rare case of malignant schwannoma of the diaphragm is presented. The CT and ultrasound findings are described, correlated with the pathologic findings. During surgery, the tumor presented as a dumbbell shaped mass with central disruption of the right diaphragm.
Adult ; *Diaphragm ; Female ; Human ; Neurilemmoma/*diagnosis/radiography/ultrasonography ; Soft Tissue Neoplasms/*diagnosis/radiography/ultrasonography ; *Tomography, X-Ray Computed

Although primary cardiac lymphoma was a near fatal disease in the past, recent advances in imaging diagnosis and chemotherapy have dramatically improved survival. We describe the CT and MR findings of primary cardiac lymphoma in two immunocompetent subjects who recovered after chemotherapy. The primary cardiac lymphomas manifested as a poorly enhancing mass on CT, relatively hyperintense on a T2-weighted image and a heterogeneously enhanced mass on contrast-enhanced MR. The tumor also showed a predilection for right heart chambers and contiguous infiltration along adjacent structures.
Adult ; Case Report ; Female ; Heart Neoplasms/*diagnosis ; Human ; Lymphoma, B-Cell/*diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Age ; Tomography, X-Ray Computed

PURPOSE: To evaluate the role of CT and CT features in the diagnosis of bronchogenic carcinomas not detected by plain radiography. MATERIALS AND METHODS: Eighteen patients [19 primary cancer lesions, M:F=16:2, aged 43 -75 (mean, 56.3)years] with lung cancer initially not detected by plain radiography were involved in this study. CT scanning was performed in all cases, and fibrobronchoscopy, and sputum cytology. each in 17. Lesions were divided into two groups: the central type, if on or proximal to the segmental bronchus, and the peripheral type, if distal to this. Plain radiographs were analysed for possible causes of occultness and for clinical characteristics including cell type, location, and size. We focused on the CT findings, comparing cases undetected by CT with those undetec6ted by bronchoscopy. RESULT: In the central type, the cause of occultness, as seen on plain radiographs, was small size, no secondary findings, or confusing shadow from hilar vessels. In the peripheral type, the cause was overlapping shadow due to normal structures of the chest, or combined diseases. Eight lesions were first detected by sputum cytology, 6 by bronchoscopy, and 5 by CT. Fourteen lesions were the central type (main bronchus 2, lobar bronchus 7, segmental bronchus 5), and five were peripheral. Central-type lesions were either squamous cell carcinoma (n =11), adenocarcinoma (n =1), small cell carcinoma (n =1), or large cell carcinoma (n =1). The peripheral type were either squamous cell carcinoma (n =2), adenocarcinoma (n =2), or large cell carcinoma (n =1). Size ranged from 0.2 to 4(mean, 2; central 1.7, peripheral 2.8) cm. Surgical resection was possible in 15 patients (16 cancers, including 13 at stage I). Only two were at a stage which rendered them unresectable. CT revealed 13 cancers, including all those which were peripheral. The findings were endobronchial nodule (n =4), bronchial wall thickening (n =1), perihilar mass (n =3), parenchymal mass (n =2), and subpleural mass (n =3). In six central-type cases [endobronchial mass (n =5), carcinoma in situ(n =1)], CT revealed no evidence of cancer. The mean size of these lesions was 1.1cm, and all were stage I. Bronchoscopy failed to detect five cases, including four peripheral cancers and one central. The mean size of these was 2.7 cm and all three adenocarcinomas were included in this group. In two of the five cases in which sputum cytology showed negative results, the existing condition was revealed by CT. CONCLUSION: For the detection of peripheral lung cancer, CT is better than bronchoscopy, though in cases of central lung cancer, in which CT plays a complementary role, bronchoscopy is better than complementary to bronchoscopy which is more excellent than CT in detecting central lung CT. In 68% of cases, CT revealed lung cancer which was not detected by plain radiography, and is therefore a suitable noninvasive screening method for the detection of this cancer.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinoma, Bronchogenic* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis* ; Humans ; Lung ; Lung Neoplasms ; Mass Screening ; Radiography ; Sputum ; Thorax ; Tomography, X-Ray Computed

Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin’s lymphoma arising from a B-cell lineage characterized by the formation of malignant effusion in body cavities without evidence of a detectable tumor. The effusion contains tumor cells universally infected with human herpesvirus 8 (HHV8), which is the critical factor differentiating PEL from HHV8-unrelated PEL-like lymphoma (PEL-LL). This report describes a 77-year-old male patient with pleural effusion and ascites, containing lymphoma cells expressing a B-cell phenotype, but without markers of HHV8 in immunocytochemical analysis. The patient was diagnosed with PEL-LL and treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), which resulted in a complete remission. The patient is currently disease-free 15 months post-treatment. To the best of our knowledge, this is the first report on administration of R-CHOP in a PEL-LL patient in South Korea.
Aged* ; Ascites ; B-Lymphocytes ; Cyclophosphamide* ; Doxorubicin* ; Herpesvirus 8, Human ; Humans* ; Korea ; Lymphoma* ; Lymphoma, Primary Effusion ; Male ; Phenotype ; Pleural Effusion ; Prednisolone* ; Rituximab* ; Vincristine*

BACKGROUND: The hemodynamic superiority of total cavopulmonary anastomosis (TCPA) over atriopulmonary connection as a modification of Fontan-type operation, began to be acknowledged with more applications to clinical cases. The need of adequate resolutions for the investigation and improvement of residual hemodynamic derangements including abnormal distribution of the pulmonary blood flow, is emerging. METHODS: We studied 20 patients (M:F=12:8, age:67.9+/-41.5 months) who have had the TCPA and were followed-up by cardiac catheterization, angiography and lung perfusion scan 24.5+/-15.7 months after the operation. Pulmonary arterial growth and hemodynamic influences including the pulmonary blood flow distribution were investigated to verify the appropriateness of the conventional TCPA method and to aid in the determination of the consequences and prognosis of the operation. RESULTS: The mean pulmonary arterial pressure before and after the operation was 15.1+/-3.2 mmHg and 13.9+/-4.8 mmHg respectively without significant difference and there was no significant postoperative changes in the cross-sectional area index of pulmonary artery in regard to the variability of body surface area. The pulmonary blood flow was distributed with a greater amount in the ipsilateral side of IVC flow entrance (IVCipsi) than the contralateral side (IVCcontra), with an ipsilateral to contralateral perfusion ratio (i/cPR) of 1.24+/-0.42. Comparing the subgroups by the type of superior vena caval inflow, unilateral superior cavopulmonary anastomosis (SCPA) group showed significantly higher i/cPR (1.47+/-0.33) than the bilateral SCPA group (1.07+/-0.21). Comparing the subgroups by the type of IVC inflow, the i/cPR of the intraatrial tunnel group was higher than the hemiazygous continuation group, but there was no statistical significance. CONCLUSION: TCPA does not influence the growth of pulmonary artery, and the type of cavopulmonary anastomosis and the bilaterality of superior vena cava may have major influences on the distribution of the pulmonary blood flow. The details of surgical methods should be evaluated case by case in respect to the associated anomalies in order to achieve adequate postoperative pulmonary blood flow distribution.
Angiography ; Arterial Pressure ; Body Surface Area ; Cardiac Catheterization ; Cardiac Catheters ; Fontan Procedure ; Heart Bypass, Right* ; Hemodynamics ; Humans ; Lung ; Perfusion ; Prognosis ; Pulmonary Artery ; Pulmonary Circulation* ; Vena Cava, Superior