Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.
Arthroscopes ; Humans ; Magnetic Resonance Imaging ; Methods ; Rotator Cuff* ; Suture Anchors ; Sutures ; Tendons

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies

Cholesterol granuloma is thought to arise as the consequence of obstruction of the air cell system. Once the ventilation is blocked, negative pressure builds with mucosal hemorrhage and blood extravasation into the air cell system. And the catabolism of blood releases cholesterol, hemosiderin, lipids and fibrin. It is the foreign body reaction of these products that leads to cholesterol granuloma and cholesterol granuloma cyst formation. The cholesterol granuloma and cholesterol granuloma cyst may develop in any portion of the pneumatic system of the temporal bone and small lesions are commonly encountered in the middle ear and mastoid air cells. But, huge cholesterol granuloma cyst is a unusual lesion and cholesterol granuloma cyst with extensive temporal bone destruction and intracranial extension has been rarely reported. Recently we experienced a case of huge cholesterol granuloma cyst with intracranial extension in a 38-year-old female, and report this case with review of literatures.
Adult ; Cholesterol* ; Ear, Middle ; Female ; Fibrin ; Foreign-Body Reaction ; Granuloma* ; Hemorrhage ; Hemosiderin ; Humans ; Mastoid ; Metabolism ; Temporal Bone* ; Ventilation

Cholangiolocellular carcinoma is a rare lesion, intermediate in type between hepatocellular and cholangio-cellular carcinoma. The radiologic findings of cholangiolocellular carcinomas have not been reported. We describe the ultrasound, CT, MR, and angiographic findings of a case of cholangiolocellular carcinoma not associated with liver cirrhosis.
Liver Cirrhosis ; Ultrasonography

Acute acquired comitant esotropia has been used to describe a dramatic onset of a relatively large angle of esotropia with diplopia and minimal refractive errors. The authors experienced two cases of acute acquired comitant esotropia in patients with the age of 28 and 40 years. Sudden diplopia and esodeviation developed in both patients. All ophthalmologic and neurologic examinations including brain MRI showed negative results. Amount of deviation remained constant. We performed recession of both medial rectus muscles. Four weeks after surgery, both patients showed orthotropia without any complaints of diplopia.
Brain ; Diplopia ; Esotropia* ; Humans ; Magnetic Resonance Imaging ; Muscles ; Neurologic Examination ; Refractive Errors

PURPOSE: To present a new classification based on the CT and MR imaging findings of buccal space lesions, and to propose guidelines for their radiologic differentiation. MATERIALS AND METHODS: Sixty-two histopathologically confirmed or clinically diagnosed buccal space lesions were classified on the basis of their morphologic appearance and extension to adjacent space as either (1) a mass with a distinct margin, confined to the buccal space; (2) a mass with surrounding infiltration, confined to the buccal space; or (3) a multi-space occupying mass. RESULTS: Type 1 included pleomorphic adenoma, ex-pleomorphic adenoma, carcinoma, B-cell lymphoma, acinic cell carcinoma, rhabdomyosarcoma, glomus tumor and ameloblastoma, and differentiation between malignant and benign neoplasms was not possible. Type 2 included adenoid cystic carcinoma, abscess, complicated dermoid cyst, and Kimura disease. T-cell lymphoma, neurofibroma, vascular malformation, inflammation, and foreign body granuloma pertained to type 3, and each type-3 entity showed different imaging characteristics. CONCLUSION: This new classification based on CT and MR imaging characteristics may provide useful guidelines for predicting the differential diagnosis of buccal space lesions.
Abscess ; Adenoma ; Adenoma, Pleomorphic ; Ameloblastoma ; Angiolymphoid Hyperplasia with Eosinophilia ; Carcinoma, Acinar Cell ; Carcinoma, Adenoid Cystic ; Classification* ; Dermoid Cyst ; Diagnosis, Differential ; Glomus Tumor ; Granuloma, Foreign-Body ; Inflammation ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; Magnetic Resonance Imaging* ; Neurofibroma ; Rhabdomyosarcoma ; Vascular Malformations

OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate

PURPOSE: The purpose of this study is to compare the two prosthesis that used for total ankle arthroplasty. MATERIALS AND METHODS: From Sept. 2003 to Jun 2006, 13 patients and 14 ankles that could be follow up more than 1 months. Semiconstrained type (Group I, 7 cases) and Unconstrained type (Group II, 7 cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 29 months. The criteria to compare the clinical result were postoperative range of motion, AOFAS score and residual bone stock of medial malleolus. RESULTS: Postoperative range of motion of group I was 43.6+/-9.4 degrees and of group II was 50.7+/-7.3 degrees (p=0.115). Postoperative AOFAS score of group I was 77.1+/-13.0 points and of group II was 86.0+/-5.7 points (p=0.094). Resected bone stock in medial malleolus of group I was 10.7+/-2.5 mm and of group II was 5.1+/-1.2 mm (p=0.003). Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem. CONCLUSION: In our hospital, mobile bearing type prosthesis shows good result than a semiconstrained type in respect of residual bone stock in medial malleolus. Postoperative range of motion and AOFAS score between two groups shows no significant difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.
Ankle* ; Arthroplasty* ; Female ; Follow-Up Studies* ; Humans ; Male ; Mobile Health Units ; Osteotomy ; Prostheses and Implants ; Range of Motion, Articular ; Skin

PURPOSE: To determine the problems of anterior external fixators in unstable pelvic ring injuries. MATERIALS AND METHODS: We reviewed 25 patients with an unstable pelvic ring injuries who had been treated with only anterior external fixator over one year follow-up. By Tile's classification, type B 14, type C 11 and the radiological results were evaluated preoperation, postoperation and bone union state. The clinical evaluation was done in termas of the residual pain, discrepency in limb length, rotational deformities, gait disturbance, neurologic deficiency. RESULTS: In 25 patients with an unstable pelvic ring injuries, 18 (72%) patients were reducted and 3 (17%) patients of 25 were reduction failure at last follow up, they were all Tile type C. The residual pain was graded normal 3, mild 11, moderate 10, severe 1 respectively. The cases with discrepency in limb length and gait disturbance were 6 (all type C), 10 (type B 3, type C 7) respectively. The complication were 4 pin site infection, 3 pressure sore and 1 pyogenic hip arthritis. CONCLUSION: Our results indicate that anterior external fixator should be limited to vitally unstable patients in acute resuscitative phase and cases without vertical displacement.
Arthritis ; Classification ; Congenital Abnormalities ; External Fixators ; Extremities ; Follow-Up Studies ; Gait ; Hip ; Humans ; Pressure Ulcer

Ushers syndrome is an autosomal recessively inherited entity which is characterized by a retinitis pigmentosa and congenital sensorineural hearing loss. This syndrome represents different clinical features according to its subtypes. We experienced one case of type 1 Ushers syndrome, who had congenital hearing loss, visual field loss, visual loss of early childhood onset. We performed bilateral cataract extraction. Fundus examination after operation showed characteristic findings of retinitis pigmentosa. ERG was non-recordable ERG. Her audiogram confirmed the bilateral sensorineural hearing loss.
Cataract Extraction ; Cataract* ; Hearing Loss ; Hearing Loss, Sensorineural ; Retinitis Pigmentosa ; Usher Syndromes* ; Visual Fields