In the treatment of proximal tibial condyle fracture, it should be considered that it can often accompany injuries of the collateral ligament, both cruciate ligament, and the menisci of the knee. Moreover it is necessary to restore anatomical congruity of the articular surface accurately. We performed reduction of the depressed articular fragment under monitoring of arthroscopy and fixed with cannulated cancellous screws and accompanied by bone graft under the control of image intensifier in 2 cases of Type I(Pure cleavage) and 3 cases of type II(cleavage with depression) fractures. The results were very satisfactory. Arthroscopy assisted reduction and fixation are very useful method in the treatment of proximal tibial condyle fracture because of (1) the minimized operative morbidity, (2) the ability to evaluate and manage associated intraarticular pathology simultaneously, (3) the rapid rehabilitation, (4) the achievement of good reduction comparable to open reduction.
Arthroscopy ; Collateral Ligaments ; Knee ; Ligaments ; Methods ; Pathology ; Rehabilitation ; Transplants

Owing to the advancement of imaging techniques which include the CT scan, it became easier to evaluate fracture patterns of calcaneal fractures accurately. Moreover, it is possible to obtain good results with operative treatment as a consequence of the development of good operative equipment and new operative technique. In 1988, Regazzoni and Benirschke in 1990, recommended L-shaped extensive lateral approach for calcaneus which provide extensive exposure of calcaneus and so allow easier reduction and fixation. We carried out L-shaped extensive lateral approach in 11 cases from June, 1993 to April, 1994. This approach did not produce any skin problems and allowed excellent anatomical reduction and fixation. But we experienced some severe causalgia on the heel region in several cases. We tried to analyse the cause of pain and concluded that it was the damage to the lateral calcaneal branch of the sural nerve. We are reporting the problems of tbis approach.
Calcaneus ; Causalgia ; Heel ; Skin ; Sural Nerve ; Tomography, X-Ray Computed

A 63-year-old Korean man presented with generalized, asymptomatic, discrete papules and coalescent annular plaques for one year. Interestingly, the patient complained of conjunctival congestion, concurrently with aggravation of the skin lesion. Histopathologic findings of the skin lesion and conjunctiva revealed giant cells engulfing fragmented elastic fibers, and a diagnosis of actinic granuloma with ocular involvement was made. Ten months later, the patient revisited with a two-week history of bilateral temporal headache, neck pain, intermittent jaw claudication, and blurred vision. Biopsy of the temporal artery confirmed the clinical diagnosis of temporal arteritis. Both actinic granuloma and temporal arteritis show similar pathologic process, and this case supports the hypothesis that actinically degenerated elastic tissue is likely to be the antigenic basis of actinic granuloma of the skin and temporal arteritis.
Actins* ; Biopsy ; Conjunctiva ; Diagnosis ; Elastic Tissue ; Estrogens, Conjugated (USP) ; Giant Cell Arteritis* ; Giant Cells ; Granuloma* ; Headache ; Humans ; Jaw ; Middle Aged ; Neck Pain ; Skin ; Temporal Arteries

To date, there are limited data and little consensus on treatment strategies for huge hepatocellular carcinoma (HCC). Surgical resection provides significantly better survival than other modalities for single large HCC regardless of tumor stage. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is considered an alternative treatment option for HCC. Herein, we present a case of huge HCC that was successfully managed by SBRT. Transarterial embolization, previously performed in Russia, was incomplete. It was also not suitable for resection and transarterial chemoembolization. Although the rationale for radiotherapy in huge HCC was insufficient, SBRT was performed because no other treatment options were available. Additional radiofrequency ablation was performed for small HCC in a different segment, and radiological complete response (CR) was achieved. The CR was maintained over 4 years. Therefore, SBRT may be an alternative treatment option for large HCC that is not suitable for curative treatment.

Menetrier's disease is a rare, characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss, and edema due to gastric protem loss. A 64 year old male patient was admitted with the chief complaint of epigastric discomfort. Endoscopic, radiologic and histologic examination, revealed characteristic findings of Menetrier's disease. A case of Menetrier's disease is reported with a brief review of literature.
Edema ; Gastritis, Hypertrophic* ; Humans ; Male ; Middle Aged ; Stomach ; Weight Loss

The authors present a series of 35 patients who underwent operation for metastatic spinal tumor. Patients were operated via anterior, posterior or posterolateral and combined anterior-posterior approach. The anterior approach was used in cases where there was no involvement of the posterior column, tolerable of a thoracotomy and involvement of three or less adjacent vertebral bodies. The posterior or posterolateral approach was used in cases with involvement of the posterior column, disease at two seperated locations, intolerable of a thoracotomy and involvement of three columns. The combined anterior-posterior approach was used when it was not enough to obtain stabilization with anterior or posterior approach alone and expected greater than 1 year life expectancy. Twenty-five(89%) of the 28 patients improved neurologically following surgery. Average neurologic improvement was 1.3 Frankel grade. Pain relief was obtained in twenty-six(93%) of the 28 patients. Recovery of spincter change was obtained twelve(80%) of the 15 patients. Two patients died postoperatively due to DIC and pneumonia. Prior to operation, selective spinal angiography and embolization were performed in nine patients with metastases from renal carcinoma, thyroid cancer and hepatoma to reduce intraoperative bleeding. The authors believe that the choice of surgical approach has to be individualized for each patient depending on extent and location of the tumor, general condition of patient, goal of therapy and life expectancy.
Angiography ; Carcinoma, Hepatocellular ; Dacarbazine ; Hemorrhage ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Pneumonia ; Thoracotomy ; Thyroid Neoplasms

The authors present a series of 12 patients who underwent one-stage spondylectomy, vertebral reconstruction, posterior segmental stabilization for malignant metastatic disease. Major indication for this approach includes three column involvement or untolerable thoracotomy. This operative method involved the spondylectomy via a bilateral transpedicular or unilateral extracavitary approach, vertebral body reconstruction with methlymethacrylate (MMA), and posterior stabilization with sublaminar wiring in one stage. Postoperatively, all patients improved neurologically. Average neurologic improvement was 1.5 Frankel grade. Pain relief was obtained in all patients. Recovery of sphincter change was obtained 7(88%) of the 8 patients. One patient died postoperatively due to pneumonia. Spinal alignment was maintained in all. The major advantage of this approach is that circumferential decompression of the spine and stabilization can be obtained safely by one stage.
Decompression ; Humans ; Neoplasm Metastasis* ; Pneumonia ; Spine ; Thoracotomy

Malignant peripheral nerve sheath spinal tumours are relatively rare. A primary spinal location at the first onset is rarely reported in the literature, thus the clinical features and therapeutic results of these spinal malignant tumours are not defined. We describle three patients with primary spinal malignant schwannomas and stress the surgical mananement of these cases.
Humans ; Neurilemmoma* ; Peripheral Nerves

BACKGROUND: Since 1983, vaccination for Hepatitis B virus(HBV) has been recommended for all neonates in Korea. Therefore, significant change of HBsAg positive rate is expected. The objective of this study is to investigate HBsAg positive rate of grade, junior high, and high schoolers in Kangwon Province. METHODS: From 1997 to 1999, total 120,220 subjects, who were born in 1981 to 1992, were enrolled in this study. HBsAg and anti-HBs were tested by reversed passive hemagglutination and passive hemagglutination, respectively. If their results had been vague, we perfomed enzyme-linked immunosorbent assay for confirmation. RESULTS: HBsAg positive rate of entire study group was 2.5%(3,045 out of 120,220). Those of schoolboys and schoolgirls were 2.6%(1,567 out of 60,076), 2.5%(1,478 out of 60,144), respectively. Significant statistical difference was not observed in comparison of HBsAg positive rate according to sex(p=0.09). HBsAg positive rate of grade schoolers was 1.4%(676 out of 48,871), which was significantly lower than that of junior high(3.2%, 557 out of 17,577) and high-schoolers(3.4%, 1,812 out of 53,772)(p< 0.01). From 1997 to 1999, HBsAg positive rate has significantly decreased from 2.8%(1,434 out of 50,434) to 1.9%(407 out of 20,991)(p< 0.01). HBeAg positive rate of HBsAg positive subjects was 62.9%(1,000 out of 1,590). CONCLUSION: HBsAg positive rate of grade-schoolers in Kangwon province Korea, tended to be lower than that of junior high, or high-schoolers, and is also thought to be lower than that of the past, which was caused by nationwide vaccination programme.
Enzyme-Linked Immunosorbent Assay ; Gangwon-do* ; Hemagglutination ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Humans ; Infant, Newborn ; Korea ; Vaccination

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult ; Amniotic Fluid* ; Anaphylaxis ; Anoxia ; Cardiopulmonary Bypass ; Cesarean Section ; Cognition ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnant Women ; Pulmonary Circulation ; Shock