No abstract available.
Caroli Disease*

Isolated dislocation of all five carpometacarpal joints is extremely rare, only eleven cases had been reported since 1873. In Korea, we have not seen it probably. We experienced one case of isolated dislocation of all five carpometacarpal joints with a good result in I year after closed reduction and internal fixation.
Carpometacarpal Joints* ; Dislocations* ; Korea

Isometric positioning of the ACL graft is an important consideration in successful reconstruction of the ACL-deficient knee. The purpose of this study is to get a certain guideline in the endoscopic one-tunnel technique of anterior cruciate ligament reconstruction by measuring the skin angle and determine the degree of minimum flexion of the knee joint during femoral tunneling and interference screw fixations. To get the guide lines, first we get the tibial tunnel angle parallel to the Blumensaat's line from fully extended lateral knee joint radiography. Secondly measure the differences between angles of the femur-tibia shaft and anterior thigh-leg skin. Then measure the minimum femur-tibia flexion angle does not perforated the posterior cortex of the distal femur during femoral tunneling. Intraoperative measuring the angle between interference screw guide pin and tibial tunnel to get the parallelism of the femoral tunnel and interference screw. The results were as follows; The average femur-tibia shaft angle with 30degrees anterior thigh-leg skin angle was 30.2+/-1.75degrees, with 45degrees was 45.2+/-1.23degrees, with 60degrees was 61.9+/-4.23degrees, with 75degrees was 78.6+/-2.62degrees, with 90degrees was 97.8+/-3.96degrees. Predetermined sagittal tibial tunnel vector on the 0degrees extension knee joint lateral radiographs were applied to the several knee joint dynamograms. The mean minimum flexion angle of the femur-tibia shaft that doesn't perforate the posterior cortex of the femur was 45+/-1.58degrees (male), 44.5+/-4.97degrees (female). The average angle between interference screw guide pin and tibial tunnel was 23.0+/-2.23degrees. The findings of the present study suggest that anterior thigh-leg skin angle can be used instead of the true femur-tibia shaft angle. Less knee flexion angle makes good arthroscopic view during the tibio-femoral tunneling and interference screw fixation.
Anterior Cruciate Ligament Reconstruction ; Femur ; Knee Joint* ; Knee* ; Radiography ; Skin ; Transplants

A xanthoma is an abnormal localized collection of histiocytic tissue containing lipid. It is not a true tumor, but is a reactive histiocytic proliferation often secondary to alternations in serum lipids. Xanthoma lesions are seen in the skin and tendons, and may occur at other sites, such as the stomach and arytenoepiglottic fold. However, a xanthoma is rare in the bladder, with only 9 reported cases. Here, a case of a xanthoma of the bladder detected incidentally during cystoscopic examination for a gross hematuria is reported.
Hematuria ; Skin ; Stomach ; Tendons ; Urinary Bladder* ; Xanthomatosis*

Balloon dilatation has been applied in treatint of various pathologic narrowing of the hollow viscus. It is now accepted as very effective modality especially in treating esophageal stenosis obviating surgical procedure. We performed 128 balloon dilatations in 29 patients with the number of dilatations in each patient ranging from once to 12 times. The age distribution of the patients was from 3 weeks to 6 years, with the median age of 3 months. Twenty nine patients consisted of 25 postoperative esophageal strictures (21 esophageal atresia with tracheoesophageal fistula, 1 congenital esophageal stenosis, 2 tracheobronchial remnant, and 1 congenital esophageal stenosis with esophageal atresia), 2 achalasia, 1 congenital esophageal stenosis, and 1 corrosive esophagitis. We had successful dilation in 22 patients, who showed subsequent relief of symptoms and improvement in the diameter of stenotic segment. In 4 patients, esophageal perforation occurred during the procedure, one requiring emergency thoracotomy and the other threeconservative management. Seven patients had no improvement in stenotic sites after several balloon dilatations. Failed cases were congenital stenosis, achalasia, corrosive esophagitis and four postoperative strictures. We believe that balloon dilatation is the procedure of choice in the treatment of postoperative esophageal stricture in infants and children and is a safe method as the perforation which can complicate the procedure could be managed conservatively.
Age Distribution ; Child* ; Constriction, Pathologic* ; Dilatation* ; Emergencies ; Esophageal Achalasia ; Esophageal Atresia ; Esophageal Perforation ; Esophageal Stenosis ; Esophagitis ; Humans ; Infant* ; Methods ; Thoracotomy ; Tracheoesophageal Fistula

PURPOSE: The purpose of this study was to analyze the effect of the medical research curriculum on the students' satisfaction and the research self-efficacy. METHODS: The curriculum was implemented to 79 graduate medical school students who entered in 2007 and 2008. This curriculum is implemented through 3 years consisting of 5 different sub-courses: Research design, Research ethics, Medical statistics, Writing medical paper, and Presentation. The effect of this program was measured with 2 self-administered surveys to students: the course satisfaction survey and the self-efficacy inventories. The Research Self-Efficacy Scale consisted of 18 items from 4 categories: Research design, Research ethics, Data analysis, and Result presentation. The descriptive statistics, paired t-test, and analysis of covariance (ANCOVA) were implemented. RESULTS: The average point of satisfaction of the course was 2.74 out of 4, which told us that students generally satisfied with the course. The frequencies of tutoring for research course were 2 or 3 times on average and each session of tutorial lasted 1.5 to 2 hours. The research self-efficacy in three categories (Research design, Research ethics, and Result presentation) increased significantly (p<0.1). The self-efficacy of the male students was higher than females' one. The self-efficacy was not significantly different by the experience of research paper writing at undergraduate level. CONCLUSION: The curriculum showed positive results in cultivating research self-efficacy of students. There is a need for improvement of the class of Statistical analysis as students reported that it was difficult.
Curriculum ; Education, Medical, Graduate ; Equipment and Supplies ; Ethics, Research ; Humans ; Male ; Research Design ; Schools, Medical ; Self Efficacy ; Statistics as Topic ; Students, Medical ; Writing

PURPOSE: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. MATERIALS AND METHODS: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. RESULTS: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. CONCLUSION: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.
Amputation ; Ankle ; Arthritis ; Emergencies ; Follow-Up Studies ; Foot ; Fractures, Open ; Humans ; Incidence ; Knee ; Osteoarthritis ; Osteomyelitis ; Retrospective Studies ; Soft Tissue Injuries ; Tibia ; Ulcer ; Wound Infection ; Wounds and Injuries

PURPOSE: To review the type, incidence and radiologic findings and to evaluate the clinical significance of intrahepatic duct dilatation of choledochal cysts in children. MATERIALS AND METHODS: Ultrasonography and operative cholangiography of 49 consecutive children with surgically confirmed choledochal cyst were reviewed and classified according to the Todani's classification. Patients with intrahepatic duct dilatation in preoperative evaluation were routinely followed by ultrasonography after surgery of extrahepatic bile duct. The status of bileduct was evaluated by comparing with the preoperative ultrasonography. RESULTS: According to the preoperative evaluation, there were 19 cases(39%) of type Ia, three cases(6%) of type Ib, ten cases(20%) of type Ic, 15 cases(31%) of type IVa, two cases(4%) of type V, but no case of the type II, III, IVb in Todani's classification.In twelve of 13 patients (five cases of type I and eight cases of type IVa) who had been followed up after surgery of choledochal cyst, the previously noted intrahepatic ductal dilatation were no longer seen. CONCLUSION: The incidence of the types of choledochal cysts by Todani's classification shows no significant difference between our result and the other authors'. The intrahepatic ductal dilatation seems to be reversible and mainly secondary to extrahepatic obstruction by choledochal cyst. Thus, postoperative follow up examination is more important than preoperative classification of bile duct dilatation.
Bile Ducts ; Bile Ducts, Extrahepatic ; Child* ; Cholangiography ; Choledochal Cyst* ; Classification ; Dilatation ; Follow-Up Studies ; Humans ; Incidence ; Ultrasonography

BACKGROUND: We had undergone this study to investigate clinical progress of this disease and to decide the role of aggressive diagnostic approaches, the efficacy of treatments and prognoses. METHODS: A retrospective study was done on 113 patients who had been diagnosed to metastatic adenocarcinoma of pleura by pleural fluid cytology (106 cases) or pleural needle biopsy(22 cases), at Presbyterian Medical Center, from Jan. 1990 to Dec. 1994. RESULTS: 1) The patients were composed of 59 males(52.2%) and 54 females(47.8%), and the mean age distribution was 57.4 +/- 12.1 years. 2) The site of origin was lung cancer 46.9%(53/l 13), stomach cancer 20.4%(23/113), breast cancer 11.5%(13/113), and unknown primary site 6.2%(7/113 cases), as a whole. In male, lung cancer was 55.9%(33/59), stomach cancer was 28.8%(17/59), and in female, lung cancer was 37% (20/54), breast cancer was 24.1% (13/54) of cases. 3) The cardinal symptoms were dyspnea(69%), cough(61%), chest pain(50%), weight loss(50%), anorexia(49%), sputum(43%), malaise(30%). 4) The pleural fluid findings were exudative in 94.4%(102/108), serosanguinous or bloody in 36~53%, unilateral involvement in 74.3%(84/l 13) of cases, and lymphocyte predominance (71 +/- 27%) in differential count of WBC. 5) CEA levels in pleural fluid or plasma were over 10ng/ml in 60.6% (40/66), and ADA levels in pleural fluid were under 40U/L in 95% (57/60) of cases. 6) The patients were managed by various methods, but the efficacy of treatment was uncertain. 7) The mean survival time was 12.7 +/- 13.5 weeks. CONCLUSION: It seems to be no effective treatment methods yet and the prognosis was very poor in this disease, so the objectives of diagnostic approaches and treatment methods should be directed to early diagnosis, treatment and prevention of curable disease. And we must make our best endeavors to lengthen the survival time and improve the quality of patients' life.
Adenocarcinoma* ; Age Distribution ; Breast Neoplasms ; Early Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lymphocytes ; Male ; Needles ; Plasma ; Pleura* ; Prognosis ; Protestantism ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Thorax

PURPOSE: To assess the usefulness of MRI in the preoperative diagnosis of breast implant-relatedcomplications. MATERIALS AND METHODS: Thirty four breast implants in 17 patients were examined. Eight breasts hada history of repeated surgery due to rupture and in eight others, simultaneous interstitial silicone injection hadbeen performed. MR images of the 34 implants were prospectively analyzed for implant-related complications,without prior clinical information, and the findings were compared with the results of surgery. RESULTS: Theimplant-related complications seen on MRI were infections in three cases, seromas in two, and implant malpositionin two. The linguine sign was seen in eight cases and intraparenchymal silicone in 17. Among the 32 removedimplants, rupture was genuine in ten cases (nine, extracapsular; one, intracapsular). In evaluating the MRfindings of implant rupture, the linguine sign showed 80% sensitivity, 100% specificity and 93.8% accuracy.Intraparenchymal silicon also revealed high sensitivity (90%), but relatively low specificity and accuracy (63.7%and 71.9%, respectively); this was due to the difficulty of differentiating granulomas still present after aprevious rupture from injected silicone material. MRI was useful for visualization of implant migration, thedirect relationship of extended or extruded silicone in extracapsular rupture and the localization of siliconegranulomas, as seen on multiplanar images. The extent of infection was clearly demonstrated on contrast enhancedscan. There was relatively good correlation between the degree of contracture seen on physical examination andthat seen on MRI. CONCLUSION: MRI was an effective and useful method for the preoperative evaluation ofimplant-related complications; degree of contracture was successfully predicted.
Breast Implants ; Breast* ; Contracture ; Diagnosis ; Granuloma ; Humans ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies ; Rupture ; Sensitivity and Specificity ; Seroma ; Silicones