Fractures of the proximal humerus occur more frequently in older patients but are seen in all ages and emerge epiphyseal separations. The objectives of treatment are restoration of all involved structures to normal anatomical state and a completely functional limb in the shortest time possible. One part and two part fractures were indicated in conservative treatment and surgical treatment in most of three, four part fractures. The results of treatment of forty four cases according to Neer's classification were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital from Mar. 1978 to Dec.1985. The results were as follows. 1. The prevalent age distribution was third and fifth decade(48%) . 2. The most common cause of injury was slip down(14 cases, 32%). 3. The most frequent cases of the fractures in Neer's classification were two part fractures(22 cases, 50%). 4. Thirty one cases(71%) were treated by conservative treatment, twelve cases(27%) by open reduction and 1 case(2%) by prosthesis. 5. Good results were in 23 cases(52%) of one and two part fractures, fair in 17 cases(39%) and poor in 4 cases(9%) of two, three and four part fractures.
Age Distribution ; Classification ; Clinical Study ; Extremities ; Humans ; Humerus ; Jeollabuk-do ; Orthopedics ; Prostheses and Implants ; Shoulder Fractures

Synovial chondromatosis is a rare monoarticular disorder which often involves the knee, hip and the elbow but the shoulders are less frequently affected. The diagnosis depends on the important radiographic and operative findings as well as histopathological criteria. We have experienced the synovial chondromatosis developed in the left shoulder of a 37 year-old male who was diagnosed by CT scan, axillary angiography and microscopic findings and treated at Chonbuk National University Hospital.
Angiography ; Chondromatosis, Synovial ; Diagnosis ; Elbow ; Hip ; Humans ; Jeollabuk-do ; Knee ; Male ; Shoulder ; Tomography, X-Ray Computed

Fractures of the tibial pilon are the severe injuries to the ankle joint resulted from axial compression, shear and/or rotational forces. The mangement has been notoriously difficult due to the comminution of the distal tibia, articular incongruity and soft tissue trauma. The advocated treatment sequence of fibular reconstruction, restoration of the articular suface, bone grafting of defects and the use of an anterior or medial neutralization plate, early movement and delayed weight bearing, were performed recently and the best results have been obtained. The results of treatment of 18 cases were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital and Chong ju Lee Rha Hospital from Mar. 1982 to Aug. 1989. The results were as follows. 1. The most frequent type of fracture was type III according to Ruedi and Allgower's classification. 2. The operative treatment was performed with plates and screws in fourteen cases. 3. The overall good and fair results were 72%.
Ankle Joint ; Bone Transplantation ; Classification ; Clinical Study ; Jeollabuk-do ; Orthopedics ; Tibia ; Weight-Bearing

PURPOSE: The purpose of this study is to investigate the usefulness of ultrasound-guided femorosciatic nerve block by orthopaedist to operate the fracture around ankle. MATERIALS AND METHODS: Twenty-two patients, who had an operation for fracture around the ankle under a ultrasound-guided femorosciatic nerve block from January to April 2010, were the targets of this study. We measured the time spent for the ultrasound-guided femorosciatic nerve block, the time taken to start the operation after the nerve block, the time taken to deflate the tourniquet because of a tourniquet pain, the time passed until feeling a postoperative pain after the operation, etc. We also studied the complications and satisfaction of the anesthesia. RESULTS: It took 6.2 (3 to 12) minutes for the nerve block, 46.1 (28 to 75) minutes to start the operation, 52.5 (22 to 78) minutes until feeling a tourniquet pain and 11.5 (7.5 to 19) hours until starting to feeing a postoperative pain. There was no complication by anesthesia and 21 people (95.5%) were satisfied with anesthesia by ultrasound-guided femorosciatic nerve block. CONCLUSION: Ultrasound-guided femorosciatic nerve block by orthopaedist in the fracture around ankle reduces anesthetic and nerve injury complication, and leads to high anesthetic success rate. Also it is considered as an effective method to alleviate postoperative pain.
Anesthesia ; Animals ; Ankle ; Fees and Charges ; Femoral Nerve ; Humans ; Nerve Block ; Pain, Postoperative ; Sciatic Nerve ; Tourniquets

Angioleiomyoma is an uncommon benign tumor composed of smooth muscle cells and vascular endotheliums. It is common in the uterus and the gastrointestinal tract but rare in the head and neck. This neoplasm is extremely rare in the nasal cavity, accounting for less than 1% of all vascular leiomyomas. The tumor has a benign nature and the recurrence of tumor is rare and complete removal is the treatment of choice. We present a case of angioleiomyoma which involves the nasal vestibule and was excised by a sublabial approach.
Accounting ; Angiomyoma ; Endothelium, Vascular ; Gastrointestinal Tract ; Head ; Myocytes, Smooth Muscle ; Nasal Cavity ; Neck ; Recurrence ; Uterus

No abstract available.

PURPOSE: There are so many causes of an altered mental status, including acute stroke and nonorganic causes. Making the differential diagnosis and the diagnostic approach for cases with an altered mental status represent a challenge to all emergency physicians. The serum S-100B protein concentration and the neuron-specific enolase (NSE) concentration have been used to evaluate brain damaged patients. We evaluated the usefulness of the serum S-100B protein concentration and the NSE concentration as screening tests for the patients with an altered mentality METHODS: Seventy-eight patients with an altered mentality were included in this prospective study. The patients were divided in two groups. One was the acute stroke group and the other was the non-organic cause group. We analyzed the serum S-100B protein and NSE concentrations of the two groups. We also assessed the correlation of the serum S-100B protein and NSE concentrations with the clinical and laboratory data of the two groups RESULTS: The serum concentration of S-100B was higher in the acute stroke group (median: 0.376, interquartile range: 0.18-1.05) than that in the nonorganic group (0.123, 0.087-0.307, p=0.000). The NSE level was also higher in the acute stroke group (median: 19.12, interquartile range: 14.42-27.19) than that in the non-organic group (13.71, 10.48-19.29, p=0.002). To differentiate the acute stroke group from the non-organic group, the sensitivity and specificity was 81.1% and 61.0%, respectively, at a cutoff value for the serum S-100B protein concentration of 0.14 microgram/L, and these were 81.1% and 51.2%, respectively, at a cutoff value for the serum NSE concentration of 13.71 microgram/L CONCLUSION: Our study suggests that the serum S-100B protein and NSE concentrations may be useful as screening markers for differentiating acute stroke from non-organic causes. However, further studies are needed to evaluate the relationship between the two proteins and the various diseases that have possibility to alter patients' mental status before these two proteins can be used clinically as screening tests.
Brain ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Mentally Ill Persons ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prospective Studies ; Proteins ; S100 Proteins ; Sensitivity and Specificity ; Stroke

PURPOSE: Myocutaneous flap was widely used for trochanteric pressure sore but it had many drawbacks such as donor site morbidity, dog-ear deformity and functional muscle sacrifice. We have performed fasciocutaneous flap based on perforating vessels and succeeded in overcoming its drawbacks. METHODS: We experienced 11 cases of perforator-based fasciocutaneous flap for the coverage of trochanteric pressure sore in 9 patients, 2 cases of which were bilateral. The ambulatory status of patient group is as follows: 6 of them used a wheelchair, 2 of them are free walking, 1 of them use a wheelchair or crutches. Flap was supplied by cutaneous perforating vessel of descending branch of the lateral circumflex femoral artery and the third perforating artery of the deep femoral artery. The size of wounds were from 4x6.5cm to 10x13cm. RESULTS: We did not find any flap loss or congestion except 2 partial wound dehiscences and 1 wound infection. Donor site morbidity was not found. We observed no recurrence of the pressure sore during the 2.5 year follow-up period. CONCLUSION: We considered that perforator-based fasciocutaneous flap could overcome the traditional drawbacks of the conventional myocutaneous flap and its modified flap for trochanteric pressure sore. And this flap has many advantages for covering trochanteric pressure sore without any donor site deformity and morbidity, which would greatly improve the aesthetic result.
Arteries ; Congenital Abnormalities ; Crutches ; Estrogens, Conjugated (USP) ; Femoral Artery ; Femur* ; Follow-Up Studies ; Humans ; Myocutaneous Flap ; Pressure Ulcer* ; Recurrence ; Tissue Donors ; Walking ; Wheelchairs ; Wound Infection ; Wounds and Injuries

Tuberous sclerosis is an autosomal dominant disease characterised by hamartomas (tubers) in many organ systems and the four major intracranial manifestations including cortical tubers, white matter abnormalities, subependymal nodules and subependymal giant cell astrocytoma. But there is immense variability in the clinical presentation of tuberous sclerosis and many incomplete forms (formes frustes) exist. Almost all patients with tuberous sclerosis have seizures and mental retardation. The authors experienced a 7-year-old boy with medically intractable epilepsy without any skin lesion or mental retardation. In terms of surgical standpoint for determination of extent of resection, corticectomy on the overriding cortex of right premotor and lesionectomy of periventricular calcified lesion were performed according to ictal single photon emission computed tomography(SPECT), which showed hyperperfusion in the subcortical and calcified area. Histopathologic findings showed a few cytologically abnormal neurons with extensive gliosis, containing many Rosenthal fibers, reactive astrocytes and dense calcification, composing of abundant calcospherites which suggested forme fruste tuberous sclerosis. During the follow-up period of eighteen months, seizure was free after surgery.
Astrocytes ; Astrocytoma ; Child ; Epilepsy* ; Follow-Up Studies ; Gliosis ; Hamartoma ; Humans ; Intellectual Disability ; Male ; Neurons ; Seizures ; Skin ; Tuberous Sclerosis*

PURPOSE: We have investigated the prognostic significance of the expression of basal markers for triple-negative (estrogen receptor-negative, progesterone receptor-negative and human epidermal growth factor receptor-2-negative) breast cancers (TNBCs). METHODS: An immunohistochemical study was performed on tissue microarrays constructed with 643 invasive breast carcinoma samples. We subclassified the TNBCs into basal phenotype (BP) and non-BP groups by the use of four different criteria according to the immunprofiles for cytokeratin5/6 (CK5/6), epidermal growth factor receptor (EGFR), vimentin, c-Kit, p63 and P-cadherin. The criteria consisted of criterion 1: CK5/6+ only, criterion 2: CK5/6+ and/or EGFR+, criterion 3: CK5/6+ and/or EGFR+ and/or vimentin+ and criterion 4: one or more marker(s) positive among the six basal markers. Each of these criteria, as well as the status of each individual marker, was evaluated to estimate prognosis for TNBC patients. RESULTS: Of the breast carcinomas, 165 cases (25.7%) were TNBCs. As compared with the non-TNBCs, TNBCs were associated with a larger tumor size (p=0.001), higher histological grade (p<0.001) and shorter overall survival (OS) (p=0.002) and disease-free survival (DFS) (p=0.05). Lymph node status, tumor size and expression of EGFR or c-Kit were independent prognostic factors for patients with TNBC. As compared with the non-BP, BP as defined by criterion 2 was an independent poor prognostic factor for OS and DFS among patients with a lymph node metastasis (p=0.044 and p=0.01) and among patients who received anthracycline-based adjuvant chemotherapy (p=0.009 and p=0.01, respectively). CONCLUSION: Patients with TNBCs showed a poorer prognosis as compared to patients with non-TNBCs. Selected group of the basal-like breast cancers (BLBCs) defined by the immunohistochemical profiles of basal markers showed survival differences from non-BLBCs in subgroups of TNBCs with a homogeneous clinical finding.
Breast ; Breast Neoplasms ; Cadherins ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Epidermal Growth Factor ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Phenotype ; Progesterone ; Prognosis ; Receptor, Epidermal Growth Factor ; Vimentin