Recent development of maxillofacial surgery has taken an interest in the regeneration of facial bone defects. For the reconstruction of facial bone defects, autogenous bone grafts have been widely used. However, there are some clinical problems : the morbidity of donor sites, resorption of autogenous bone graft and, the availability of the proper form and size. The purpose of this study is to find the effective solutions to above problems. The present study was designed to evaluate the roles and regenerating capacity of fibrin sealant. Fibrin sealant is a newly developed substance for hemostasis, tissue sealing and wound healing. I made the experimental study on the effects and roles of bibrin sealant in sutogenous bone graft procedure to minimize the above complications and problems. Twenty-five adult white rabbits were used as the experimental material. Three trephine defects were made by drilling on the parietal bone of each rabbit. Defect size was 8x8mm. First group consisted of the rabbits which had the artificial defect on the parietal bone as control. The defect in second group was sealed up with autogenous boon chip only. Last group comprised the rabbits autografted by mixing the bone chip with the fibrin sealant. The results were carefully examined grossly and microscopically from the 3rd day to the 28th day postoperatively. The following results were obtained ; 1. The mixture of fibrin sealant and bone chip was useful for regenerating the bone defects. Most of the defects were substituted by new bone. 2. In the case of the graft with bone chip only, most defects were also filled with new bone, but less than fibrin group. 3. In the control group, new bone was formed around the peripheral area only. A mixture of fibrin sealant and autogenous bone chip plays an effective role in forming new bone. find judging from the results of this experiment, it may be expected the much use of the fibrin sealant in maxillofacial orthopedic surgery.
Adult ; Autografts ; Bone Regeneration* ; Facial Bones ; Fibrin Tissue Adhesive* ; Fibrin* ; Hemostasis ; Humans ; Orthopedics ; Parietal Bone ; Rabbits ; Regeneration ; Surgery, Oral ; Tissue Donors ; Transplants ; Wound Healing

Osteochondromadevelop most commonly at distal femur, proximal humerus and proximal tibia, but the rib osteochondroma was reported less commonly. In this report, scapular snapping syndrome complicated by adventitious bursa and soft tissue pseudotumor surrounding the osteochondroma of the 6th rib body was treated successfully by surgical excision of them. We report this rare case with reviewing the relevant literature.
Femur ; Humerus ; Osteochondroma* ; Ribs* ; Shoulder* ; Tibia

No abstract available.
Adenocarcinoma* ; Carcinoma, Squamous Cell*

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression and lumbar interbody fusion (PILF). SUMMARY OF LITERATURE REVIEW: Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause is known to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosis and treatment of RCH is very important in the patient with suspicious symptoms. MATERIALS AND METHODS: A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosis at L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developed nausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservatively managed with clamping of the wound drainage. RESULTS: The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapy at postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2 weeks. CONCLUSIONS: Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treating surgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small.
Blood Pressure ; Brain ; Consciousness ; Constriction ; Decompression* ; Dopamine ; Drainage ; Early Diagnosis ; Female ; Headache ; Hemorrhage* ; Humans ; Hypotension ; Lumbar Vertebrae ; Middle Aged ; Nausea ; Postoperative Nausea and Vomiting ; Spinal Stenosis ; Wounds and Injuries

STUDY DESIGN: Cervical spine radiograms of 460 Jeju islanders. PURPOSE: To investigate the age-matched incidences and severity of the cervical disc degeneration and associated pathologic findings. OVERVIEW OF LITERATURE: Several related studies on the incidences of disc and Luschka's and facet joint degeneration have provided some basic data for clinicians. METHODS: Cervical radiographs of 460 (220 males and 240 females) patients in their fourth to ninth decade were analyzed. Ninety patients in their third decade were excluded because of absence of spondylotic findings. RESULTS: Overall incidence of cervical spondylosis was 47.8% (220 of 460 patients). The percentile incidences of spondylosis in the fourth, fifth, sixth, seventh, eighth and ninth decade was 13.2% (10 of 76 patients), 34.6% (37 of 107 patients), 58.9% (66 of 112 patients), 58.8% (50 of 85 patients), 70.3% (45 of 64 patients) and 75.0% (12 of 16 patients), respectively. The percentile incidences of one, two, three, four and five level spondylosis among 220 spondylosis patients was 45.5% (n=100), 34.1% (n=75), 15.0% (n=33), 4.5% (n=10), and 0.9% (n=2). Severity of disc degeneration ranged from ± to ++++, and was ± in 6.0% (24 segments), + in 49.6% (198 segments), ++ in 35.3% (141 segments), +++ in 9.0% (36 segments) and ++++ in 0.25% (one segment). Spurs and anterior ligament ossicle formed at the spondylotic segments, mostly at C4~6. The rate of posterior corporal spurs formation was very low. Olisthesis and ossification of the posterior longitudinal ligament were rarely combined with spondylosis. Cervical lordotic curve decreased gradually according to the progress of severity of spondylosis. CONCLUSIONS: The incidence of cervical spondylosis and number of spondylotic segments increase, and degeneration gradually becomes more severe with age.
Humans ; Incidence* ; Intervertebral Disc Degeneration ; Ligaments ; Longitudinal Ligaments ; Male ; Spine ; Spondylosis* ; Zygapophyseal Joint

PURPOSE: To assess the clinical difference between cubital tunnel syndrome with anconeus epitrochlearis (AE) and idiopathic cubital tunnel syndrome without known other causes. METHODS: This cross-sectional study included the 326 patients who were subjected to surgery because of cubital tunnel syndrome from 2008 to 2014. After exclusion of patients with other known causes of cubital tunnel syndrome, a total of 107 patients were divided into two groups; patients with and without AE. The clinical differences between two groups were analyzed retrospectively; age, sex, presence of intrinsic muscle atrophy, interval from symptom development to surgery, pinch power, the disabilities of the arm, shoulder and hand score and the nerve conduction velocity (NCV). RESULTS: Thirty four (10.4%) patients, being subjected to surgery had the AE. Among 107 patients who had no other known causes, 26 patients had AE. 19 out of 26 patients with AE was male. Average age of patients with AE was significantly younger. The interval from symptom development to surgery in AE patients was significantly shorter. Motor NCV of ulnar nerve at above elbow joint in comparison with that at below elbow joint in AE patient was more significantly decreased (14.3 m/sec vs. 8.3 m/sec). CONCLUSION: The AE in cubital tunnel syndrome is no more rare structure. In younger male patients with rapidly progressive worsening cubital tunnel symptoms, and if there is significant decrease of ulnar motor nerve velocity at above elbow in comparison with at below elbow, the AE should be considered as cause of ulnar neuropathy.
Arm ; Cross-Sectional Studies ; Cubital Tunnel Syndrome* ; Elbow ; Elbow Joint ; Hand ; Humans ; Male ; Muscular Atrophy ; Neural Conduction ; Retrospective Studies ; Shoulder ; Ulnar Nerve ; Ulnar Neuropathies

Tumor necrosis factor alpha (TNF-alpha) inhibitors are used widely to treat patients with active rheumatoid arthritis and ankylosing spondylitis (AS). Although various cutaneous reactions can occur as side effects of TNF-alpha inhibitors, systemic vasculitis requiring withdrawal of the agent and immunosuppressive drugs is rare. A 59-year-old male with AS who had been treated with infliximab for 60 months visited us with complaints of palpable purpura on both legs and severe abdominal pain. Abdominal computed tomography showed diffuse wall thickening of the proximal jejunum and ileum and a skin biopsy revealed leukocytoclastic vasculitis. The patient was diagnosed with Henoch-Schonlein purpura (HSP). Infliximab was discontinued and systemic steroid therapy at 0.5 mg/kg resulted in prompt resolution of the HSP. Here, we report the first case of HSP in a patient with AS after infliximab treatment.
Abdominal Pain ; Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Biopsy ; Humans ; Ileum ; Jejunum ; Leg ; Male ; Purpura ; Purpura, Schoenlein-Henoch ; Skin ; Spondylitis, Ankylosing ; Systemic Vasculitis ; Tumor Necrosis Factor-alpha ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.
Aged ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Head ; Humans ; Inflammation ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Nevus ; Recurrence ; Ulcer

When doctors evaluate the complaints of dizziness, they often perform a series of clinical tests to look for the evidence of a vestibular dysfunction. A useful procedure is to ask the patient to take deep breaths and observe the gaze behind Frenzel goggles. If hyperventilation-induced nystagmus(HIN) is detected, it is the evidence for an underlying vestibular imbalance. The authors evaluated nystagmus with electronystagmography after hyperventilation for 50 seconds. Brain imaging was performed to search the responsible lesion for dizziness. Brain MRI revealed a brain tumor suggesting vestibular schwannoma in the left cerebellopontine angle. After hyperventilation, dizziness and the right beating horizontal nystagmus with Alexander law could be detected. By precisely measuring the HIN, we determined that inputs arising from the horizontal semicircular canal were mainly responsible. The contralaterality of the direction of the horizontal component of the nystagmus was detected. We suggest that clinicians should routinely check the nystagmus after hyperventilation, when they evaluate patients complaining of dizziness.
Brain ; Brain Neoplasms ; Cerebellopontine Angle ; Dizziness ; Electronystagmography ; Eye Protective Devices ; Humans ; Hyperventilation* ; Jurisprudence ; Magnetic Resonance Imaging ; Neuroimaging ; Neuroma, Acoustic* ; Nystagmus, Pathologic ; Semicircular Canals

BACKGROUND: Intertrochanteric fractures of the femur are the most common type of fracture, and are an increasing occurrence due to the aging of the population. The objectives of our study are to predict the fate of intertrochanteric fractures treated with intramedullary hip nails by assessing the postoperative fracture stability utilizing the newly developed scoring system, and to help rehabilitate these patients. METHODS: Eighty-two patients with intertrochanteric fractures that were treated with intramedullary hip nails between December, 2004 and January, 2011 were subjected to this study. The patients who could be followed for a minimum of one year postoperatively were enrolled. The immediate postoperative conditions were determined by radiograms: reduction status (3 parameters/4 points: contact accuracy of posteromedial cortex, severity of angulation, and distraction), fixation status (3 parameters/3 points: tip-apex distance, location of tip of the lag screw, entry point of the intramedullary nail), and fracture type (1 parameter/1 point: stable or unstable type by the Kyle's classification). Postoperative reduction loss and fixation failure were checked by radiograms taken at a minimum 3 months postoperative. RESULTS: Reduction loss and fixation failure were observed in 14 consecutive patients (17%). The fixation failure rate was 100% (2 patients) in score 1, 60% (3 out of the 5 patients) in score 2, 39% (3 out of the 8 patients) in score 3, and 50% (4 out of the 8 patients) in score 4 groups. There were fixation failures only in 1 out of 13 patients with score 5, and in 1 out of 18 patients with score 6. There was no fixation failure in 17 patients with score 7 and 11 patients with score 8. CONCLUSIONS: Maintenance of the fracture reduction by the stable fixation in the patient scores over 5 could be predicted by the postoperative radiograms.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Early Ambulation ; Female ; Femur/surgery ; Fracture Fixation, Intramedullary ; Health Status Indicators ; Hip Fractures/classification/rehabilitation/*surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Treatment Outcome