PURPOSE: To evaluate the results and complications of antegrade intramedullary interlocking nailing in humerus shaft fractures. MATERIALS AND METHODS: We evaluated the clinical outcomes, radiologic results and complications in 47 patients with humerus shaft fracture treated with antegrade intramedullary interlocking nailing, and followed up until bony union. Bony union was confirmed by serial plain radiographs and the clinical outcomes were assessed according to the ASES scoring system. RESULTS: Bony union was confirmed in 41 (87.2%) out of a total 47 patients, and the mean union period was 14.5 weeks. Major complications were as follows: 6 non-union, 3 delayed union, 2 intraoperative posterior cortex fracture in the distal humerus and 2 permanent shoulder pain, including 1 case of adhesive capsulitis. The clinical outcomes were as follows: 29 excellent, 11 good, 4 fair and 3 poor. Satisfactory outcomes were demonstrated in 40 patients (85.1%). CONCLUSION: Anterograde intramedullary interlocking nailing as treatment for humerus shaft fracture showed satisfactory bony union and clinical outcomes. It is considered an efficacious treatment, especially in patients with associated injury, such as multiple fractures and segmental fracture.
Bursitis ; Fracture Fixation, Intramedullary ; Humans ; Humerus ; Nails ; Shoulder Pain

No abstract available.
Pulmonary Artery*

Aneurysms arising from ICA bifucation are relatively rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In an effort to determine their best management policy, and to improve their surgical outcome, a retrospective clinical analysis of 30 patients who underwent direct surgery from ICA bifucation aneurysm between January, 1984 and December, 1994 was performed. In the same period, total 990 patients with intracranial aneurysms were admitted in our department. The result of carotid bifucation aneurysm surgery was worse than the total surgical result. Motality and morbidity rates were 3/30(10%), 5/30(16%). Surgical complications in this group of aneurysms usually came from injury of perforating arteries, and the causes of death were intraoperative premature rupture and vasospasm. The surgical treatment of aneurysms of internal carotid bifucation is discussed, emphasizing the importance of avoiding damage to perforating vessels and premature rupture. A classification of these aneurysms, according to angiographic and anatomical considerations, is proposed. We suggest that four types of aneurysmal orientation at the bifucation of the internal carotid artery be distinguished:either projecting superiorly, anteriorly, inferiorly, or posteriorly. Posterior orientation was found in 13 cases(43.3%). Superior orientation was found in 11 cases(36.7%), inferior orientation was found in 4 cases(13.3%), and anterior orientation was found in 2 cases(6.7%). From an analysis of these cases and a review of the literature, some characteristics of these aneurysms and their surgical strategies are described.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Cause of Death ; Classification ; Humans ; Intracranial Aneurysm ; Retrospective Studies ; Rupture

Balloon dacryocystoplasty has been reported to be a safe, easy and effective nonoperative treatment for nasolacrimal stenosis. The results were not encouraging, however, because of its high failure and recurrence rates. To evaluate the feasibility of using modified Gianturco expandable metallic stents for maintenance of the dilated nasolacrimal system(NLS), 20 stents of 3 mm in diameter and 10mm long were placed in 20 nasolacrimal ducts of 10 dogs for 1 month to 10 months. It was more difficult to introduce the stents into the proximal portion(A) of the NLS than into the distal portion(B) due to the narrow and bony canal of the A portion. Twenty stents showed no migration in follow-up studies of up to 10 months. One complete occlusion occurred in a stent placed in A portion. Autopsy studies showed stents were covered with epithelium within 2 months after placement. Our experience suggest that the placement of Gianturco self-expandable stents may be a useful method of dilating and maintaining the luminal diameter of the NLS, although care must be taken to select the proper stent size.
Animals ; Autopsy ; Constriction, Pathologic ; Dogs* ; Epithelium ; Follow-Up Studies ; Methods ; Nasolacrimal Duct ; Phenobarbital ; Recurrence ; Stents*

OBJECTIVE: The results of the excision of both outer and inner membranes with fenestration to the basal and parasellar cisterns for symptomatic primary middle cranial fossa arachnoid cysts are presented. METHODS: Twenty-three symptomatic cases of middle cranial fossa arachnoid cyst treated by excision with fenestration from 1993 to 2001 at our hospital were analyzed retrospectively. RESULTS: There was no significant morbidity and mortality after surgery and no recurrence of cyst during the follow-up period(mean 40.8 months). We observed reduction of the cyst with expansion of the surrounding brain and clinical improvement in most of the patients. All cases of type III by Galassi classification, 83% of type II cases and half of type I cases were belonged to the excellent group(reduction of the cyst size over 50% during follow-up period). Seventeen cases(74%) were belonged to the excellent group and 6 cases(26%) were the good group(reduction of the cyst size under 50% during follow-up period). CONCLUSION: The results of this study suggest that the excision and fenestration procedure may be considered as the primary shunt-independent procedure in patients with symptomatic middle cranial fossa arachnoid cyst.
Arachnoid Cysts ; Arachnoid* ; Brain ; Classification ; Cranial Fossa, Middle* ; Follow-Up Studies ; Humans ; Membranes ; Mortality ; Recurrence ; Retrospective Studies

PURPOSE: Lung cancer is now one of the most frequently diagnosed cancers in the world and its incidence has been increasing also in Korea. In several recent studies, the indidence of adenocarcinoma and female/male ratio have been reported to be increasing. The aim of this study is to investigate the changing trends in sex and age distribution, the histologic type and location (peripheral or central) of tumors in lung cancer. MATERIALS AND METHODS: We performed the retrospective review of histopathology and clinical information of 1409 patients diagnosed as baving primary lung cancer, except non-epithelial tumors and undetermined histologic types, at Kyungpook National University Hospital from January 1988 to December 1996. RESULTS: Male to female ratio was 4.6; 1. The peak incidence of age group was 7th decade (40.3%) with mean age of 61.5. Percentage of smokers in patients with lung cancer was 84.3%. Total number of patients with lung cancer has increased recently. However, the annual female/male ratio was nearly constant during the study period. Peripheral tumors, which were found in 20.6% of patients with lung cancer in 1988, increased to 33.5% in 1996 and this trend was more prominent in squamous cell carcinoma than in adenocarcinoma. Squamous cell carcinoma was the most common histologic type (62.0%), followed by adenocarcinoma (19.2%), small cell carcinoma (14.2%), large cell carcinoma (4.6%) in order. There was a predominance of squamous cell carcinoma (67.9%) in males and of adenocarcinoma (46.6%) in females. There has been a significant shift in the histology pattern with an increase in the percentage of adenocarcinoma. The incidence of adenocarcinoma was more than doubled from 7.5% in 1988 to 25.8% in 1996. CONCLUSION: These findings suggest that the epidemiology of lung cancer is changing.
Adenocarcinoma ; Age Distribution ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Epidemiology ; Female ; Gyeongsangbuk-do ; Humans ; Incidence ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Retrospective Studies

Ankylosing spondylitis (AS) is a heterogeneous and systemic rheumatic disorder of unknown cause that is characterized by inflammation of the spine and sacroiliac joints. It is more common in young men. The disease is frequently associated with peripheral arthritis, enthesitis, anterior uveitis and high prevalence of HLA-B27. In some patients with AS, peripheral arthritis can occurs earlier than spinal symptom and more commonly affects the lower extremities than the upper extremities. Unlike men, women appear to have milder or atypical AS, especially at juvenile onset. However, involvement of the hands is extremely rare. Juvenile AS, defined as onset of disease prior to the age of 16 years, is considered a pediatric form of AS. On the other hand, although the atlantoaxial subluxation has been infrequently observed in patients with ankylosing spondylitis, atlantoaxial bony ankylosis has not been described in the literature. We describe a 23-year-old woman with juvenile AS who developed the atlantoaxial bony ankylosis and the hand involvement mimicking rheumatoid arthritis. Besides the rheumatoid-like hands and atlantoaxial bony ankylosis, she has shown the typical features of spondyloarthrpathy such as bilateral sacroiliitis, inflammatory spinal pain, enthesitis, severe arthritis of both hip joints, and positive HLA-B27 test.
Ankylosis* ; Arthritis ; Arthritis, Rheumatoid ; Female ; Hand* ; Hip Joint ; HLA-B27 Antigen ; Humans ; Inflammation ; Lower Extremity ; Male ; Prevalence ; Sacroiliac Joint ; Sacroiliitis ; Spine ; Spondylitis, Ankylosing* ; Upper Extremity ; Uveitis, Anterior ; Young Adult

BACKGROUND: Aortic valve stenosis induces left ventricular hypertrophy as an adaptive response to the chronic overload caused by the valve disease. Despite the fact that aortic valve replacement may lead to regression of the left ventricular hypertrophy, there is a controversy on the change of the left ventricular muscle after use of small prostheses. MATERIAL AND METHOD: We reviewed 20 patients who had undergone aortic valve replacement for aortic stenosis. There were 13 males and 7 females with a mean age of 61+/-13.8 years. A retrospective analysis of Doppler echocardiography was undertaken in preoperatively, early postoperatively(mean 10.4days), and late postoperatively(mean 29.9 months). They were divided into two groups according to the size of prosthesis used(group 1; 21 mm or smaller, group 2; 23 mm or larger). RESULT: Significant improvement of NYHA Functional class was detected in all groups. Ejection fraction was not significantly different in the group 1 between preoperative and postoperative period, however it increased significantly in the group 2 over time. But preoperative ejection fraction of the group 2 was significantly lower than that in the group 1(p=0.044). Left ventricular muscle mass index(g/m2) was not reduced significantly in the group 1 at the early postoperative period, but it was reduced significantly at the late postoperative period. In the group 2 it was reduced significantly over time. CONCLUSION: Both groups showed clinical improvement. However, the number of patients in whom 19 mm size prosthesis was used was only two. Thus, we suggest that more attention to age, BSA, and exercise should be paid in patients who will undergo aortic valve.
Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography, Doppler ; Female ; Humans ; Hypertrophy, Left Ventricular* ; Male ; Postoperative Period ; Prostheses and Implants* ; Retrospective Studies

BACKGROUND: Clinical and Radiographic studies to differentiate benign from malignant pulmonary nodules have previously focused on clinical status and the morphologic and the computed tomographic attenuation characteristics of the lung nodules. Distinctive differences in the vascularity and pathophysiology of malignant versus benign pulmonary nodules were identified. We evaluated the diagnostic method for differentiating malignant from benign solitary pulmonary nodule by contrast enhancement on the spiral CT. METHOD: Sixteen patients with solitary pulmonary nodule were examined(Tuberculoma 8, primary lung cancer 8). Serial thin section on the spiral CT was performed before and after(45second, 2min, 5min) the onset of the injection of 100mL of nonionic contrast material(2mL/sec). RESULTS: There was no difference in size of nodule and pre-contrast CT number (Hounsfield unit) between benign and malignant nodules. At forty-five second after the onset of the injection, malignant neoplasms(19.6+/-7.9 HU) enhanced significantly more than tuberculomas(4.9+/-9.4 HU, p=0.008). At 2 minute and 5 minute after, malignant neoplasms(34.0+/-19.2HU, 340+/-15.4HU) enhanced significantly more than tuberculomas (6.7+/-9.7HU, p=0.007 and 7.7+/-11.5HU, p=0.011). On cut-off value 20HU(contrast enhancement) 2 minute after the injection of contrast media, sensitivity was 87% and specificity was 87%. No correlation between the contrast enhancement and size of the nodules was observed. CONCLUSION: Studies with the use of an intravenously administered noniodinated contrast medium in examining the enhancement properties of lung nodules was performed. The contrast enhancement was useful in differential diagnosis of solitary pulmonary nodules.
Contrast Media ; Diagnosis, Differential ; Humans ; Lung ; Lung Neoplasms ; Sensitivity and Specificity ; Solitary Pulmonary Nodule* ; Tomography, Spiral Computed* ; Tuberculoma

Object of this study was to to evaluate the laterality of local cerebral cellular metabolism in various locations of the brain related to the symptomatic side of patients with clinically diagnosed idiopathic Parkinson's disease (IPD) and to verify GABA-related pathophysiology in IPD by comparing postoperative changes in (GABA+Glutamate)/Cr ratio from patients with IPD after stereotactic pallidotomy and thalamotomy. Fourteen patients with IPD(10 males and 4 females: age range 39-67 years) participated in the study. The patients were classified into two disease subgroups, one for tremor dominant group(n=7, T group), and the other bradykinesia and rigidity dominant one(n=7, B&R group). For T group, stereotactic VL(Vop, Vim) thalamotomy and subthalamotomy was performed and for the B&R group, stereotactic posteroventrolateral pallidotomy was selected. In Vivo 1H MRS study was performed on a 1.5 T MRI/MRS system(GE Sigma Advantage, version 4.8) using STEAM sequence after water suppression with CHESS RF pulse and dephasing gradients. After peak areas of creatine/phosphocreatine(Cr), choline-containning compound(Cho), N-Acetyl Aspartate(NAA), r-aminobutyric acid, (GABA) and glutamate(Glu) were calculated and processed, the metabolic ratios of NAA/Cr, Cho/Cr, and (GABA+Glu)/Cr in three different locations were calculated and compared with clinical symptoms and its changes after surgery. For the neuronal laterality in patients with IPD, there was significant differences of NAA/Cr ratio between the right and left sides of substantia nigra, thalamus and pallidum(p=0.00170). The magnitude of difference in NAA/Cr ratios between right and left side were significantly larger in substantia nigra(p=0.0141). Compared to the normal control values(1.82+/-0.52 in ages 27-50, 1.71+/-0.54 in ages 51-70 years), the neuronal loss was generally observed in at least one of three locationsin all patients. Moreover, NAA/Cr ratio was substantially lower in ipsilateral than contralateral substantia nigra of the parkinsonian symptomatic side. For preoperative(GABA+Glu)/Cr ratios of thalamus contralateral to the symptomatic side compared to that of ipsilateral, it was significant larger in thalamus of B&R group and significant smaller in T group. In the pallidotomy group, there was significant increase in the operated pallidum, whereas significant decrease in (GABA+Glu)/Cr ratios were noted in the operated side thalamus. And in the thalamotomy group, there were significant increase in the operated thalamus, whereas in the operated side pallidum, significant decrease in (GABA+Glu)/Cr ratios were noted. Neuronal laterality, pallidal neuronal loss and postoperative changes in GABA activity in patients with IPD were demonstrated on the basis of NAA/Cr and (GABA+Glu)/Cr ratio by In Vivo 1H MRS. The neuronal laterality was detected in the substantia nigra of all the parkinsonian patient, and NAA/Cr ratios in unilateral and bilateral disease were consistently lower in ipsilateral than in contralateral substantia nigra of the Parkinsonian disease side. Our result suggests that there may be another ongoing pathological process of ipsilateral neuronal degeneration with contralateral dopaminergic neuronal loss. The result of neuronal loss in pallidum supports with the previous reports concerning striatal degeneration in IPD. Our results concerning postoperative changes of (GABA+Glu)/Cr ratio suggests that separate pathophysiologic mechanisms may be involved in the development of two dominant symptom groups of IPD. That is, for the B&R group, pallidal overinhibition to the thalamus by the GABA-ergic system as previously noted, but for T group, a process other than GABA inhibitory mechanism with or without it may be involved.
Brain ; Dopaminergic Neurons ; Female ; gamma-Aminobutyric Acid ; Humans ; Hypokinesia ; Male ; Metabolism ; Neurons* ; Pallidotomy ; Parkinson Disease ; Steam ; Substantia Nigra ; Thalamus ; Tremor ; Water