PURPOSE: To investigate short term clinical outcomes of the open surgical repair for triangular fibrocartilage complex (TFCC) foveal detachment. METHODS: We retrospectively reviewed 8 patients (5 men, 3 women) who had been treated with open surgical repair of the TFCC type 1B injury, from 2005 to 2013 and who were followed up for more than one year after surgery. Mean age at time of surgery was 34 years. The right side was involved in 3 patients, and the left in 5. The clinical results of surgery were assessed with modified Mayo wrist score (MMWS), disabilities of the arm, shoulder and hand (DASH) score and pain-visual analogue scale (VAS). Physical examination was performed to evaluate the prescence of distal radioulnar instability, preoperatively and at the latest follow-up. RESULTS: The mean follow up period were 36.5 months (range, 12-64 months). The mean MMWS improved from 52.5 (range, 25-85) preoperatively to 82.5 (range, 75-100) postoperatively (p=0.02). The mean DASH score improved from 39.6 (range, 65-13.5) preoperatively to 13.4 (range, 2.5-33.3) postoperatively (p=0.012). The preoperative mean pain-VAS was 4.6 (range, 6-3); these value was reduced to mean 2 (range, 0-3) at the latest follow-up (p=0.016). There were no patients remaining instability after the surgery, although four patients showed distal radioulnar joint (DRUJ) instability before surgery. CONCLUSION: The surgical outcomes of open repair for TFCC foveal detachment (type 1B) was contentable. Also, in cases of type 1B injury associated with DRUJ instability were managed sucessfully without additional procedure.
Arm ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Physical Examination ; Retrospective Studies ; Shoulder ; Triangular Fibrocartilage* ; Wrist

Tularemia is a major laboratory acquired zoonoses caused by Francisella tularensis that have high virulence, and usually transmitted to humans from direct contact with infected wild animals like rabbits or insect vectors like ticks. Clinical tularemia can be divided with 6 major syndromes that are delineated by the mode of organism aquisition, in which ulceroglandular type is the most common. F. tularensis have 3 different biogroups which have homogeneous antigenecity, type A (biogroup tularensis), type B (biogroup palearctica) and biogroup novicida, and can be confirmed by serology most frequently. In the domestic area, there was no reports of tularemia in humans or presence of bacteria in the reservoirs. Authers experienced a case of tularemia which is suspected as F. tularensis type B, ulceroglandular type. A healthy 40-year-old man admitted the hospital for lymph node swelling in both axillary and upper arm area and for furuncles in both forearm and palm. He contacted with dead rabbit and eated it after cooking before 20 days from admission day. In laboratory cultures, F. tularensis did not grow in any of the routine or anaerobic culture media except for one blood agar plate at 5 days. After subculturing that to cystine containing chocolate agar plate at 37C degree, 5% CO2 incubator, we could see the accelerating growth of colony. In microbiological test, it was oxidase and urease negative. In acid production in cystine trypticase agar base, it was glucose positive and sucrose, maltose, glycerol negative. In agglutinating test, F. tularensis antiserum titer (Difco, USA) with isolates was 1:160 or over and antibody titer to F. tularensis antigen (Difco, USA) was 1:320 or over. Anti-F. tularensis-IF assay and Anti-F. tularensis-indirect-EIA with isolates were positive.
Adult ; Agar ; Animals ; Animals, Wild ; Arm ; Bacteria ; Cacao ; Cooking ; Culture Media ; Cystine ; Forearm ; Francisella tularensis* ; Francisella* ; Furunculosis ; Glucose ; Glycerol ; Humans ; Incubators ; Insect Vectors ; Lymph Nodes ; Maltose ; Oxidoreductases ; Rabbits ; Sucrose ; Ticks ; Tularemia* ; Urease ; Virulence ; Zoonoses

PURPOSE: To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA). MATERIALS AND METHODS: 15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson's criteria. RESULTS: The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection. CONCLUSION: Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.
Cicatrix ; Follow-Up Studies ; Forearm ; Humans ; Nails ; Pronation ; Radius ; Range of Motion, Articular ; Supination ; Ulna

Suprarenal IVC obstruction occurs rarely but has various causes. Because this obstruction proceed chronically and usually has collateral circulation, if there is no IVC or hepatic vein obstruction symptom such as Budd-Chiari syndrome, operation is usually needless. However, although symptom is not combined, if malignancy can not be ruled out and there is no proper and radiologically visible collateral, mass resection with IVC wall and bypass graft should be done. 58 year-old female patient visit the hospital for IVC mass that is occasionally discovered by routine abdominal ultrasonography examination. After abdominal CT scanning and IVC venography, IVC obstructive mass between renal vein and hepatic vein was found. Patient didn't show any abnormality in hematological examination such as coagulation and platelet counts. There was no IVC obstruction symptom such as lower limb swelling. Inferior hepatic vein was abnormally dilated and this was regarded as collateral vessel for IVC obstruction. Radiologically, primary leiomyosarcoma was not ruled out and so operation was decided. Suprarenal IVC was dissected and mass was exposed. And with the use of femoral vein and right atrium, temporally veno-veno bypass was performed. Mass including IVC wall was excised and upper end of divided IVC was sutured. Lower end of divided IVC was anastomosed with 16 mm Dacron graft and graft was anastomosed with right atrium by end-to-end methods (Cavoatrial shunt). Postoperative pathologic examination revealed the mass to be organized thrombi. After 2 weeks later, follow-up IVC venography was performed and good patency was found from IVC to right atrium through artificial bypass graft and patient was discharged without complications.
Budd-Chiari Syndrome ; Collateral Circulation ; Female ; Femoral Vein ; Follow-Up Studies ; Heart Atria ; Hepatic Veins ; Humans ; Leiomyosarcoma ; Lower Extremity ; Middle Aged ; Phlebography ; Platelet Count ; Polyethylene Terephthalates ; Renal Veins ; Thrombosis* ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography

Traumatic dislocation of the peroneal tendon is an infrequent injury. This injury is caused by forceful dorsiflexion of the foot accompanied by a powerful contraction of the peroneal muscles. This mechanism of injury tears the superior peroneal retinaculum and allows the tendons to snap anteriorly. We experienced a case of chronic recurrent dislocation of the peroneal tendon, which was treated by bone block surgery using autograft of lateral fibula and reattachment of the superior peroneal retinaculum. The clinical result was satisfactory.
Autografts ; Dislocations* ; Fibula ; Foot ; Muscles ; Tendons*

Xanthoma is characterized by collections in the lamina propria of lipid-laden macrophages or foam cells containing cholesterol land neutral fat, forming plagues or nodules in all regions of the gastrointestinal tract. But it is most common in the stomach. Once thought to be a rare entity, gastric xantoma has been reported with increasing frequency with the advent of increasing utilization of gastrofiberscopy. Because gastric xanthoma appear to be more common in patients with gasritis, gastric ulcer, and with duodenogastric reflux after gastric surgery, mucosal damage has been presumed to play a major role in their pathogenesis. Altough cholesterol and neutral fat are the major constituents of the foam cells, there is no documented relationship between degree of hyperlipidemia or hypercholesterolmia and presence of gastric xanthoma. Gastric xanthoma may be found in any portion of the stomach, and is single or multiple, usually 1 or 2 mm in diameter, rounded or oval, circumscribed, yellow or yeallow-white, and macular or nodular. We report a case of gastric xanthomatosis diagnosed by gastrofibroscopy with forceps biopsy. There are numerous, flat or slightly raised, white or yellow white lesions that range from pinpoint size to several milimeters in diameter and that are scattered through whole gastric mucosa.
Biopsy ; Cholesterol ; Duodenogastric Reflux ; Foam Cells ; Gastric Mucosa* ; Gastrointestinal Tract ; Humans ; Hyperlipidemias ; Macrophages ; Mucous Membrane ; Stomach ; Stomach Ulcer ; Surgical Instruments ; Xanthomatosis*

Lymphangioleiomyomatosis(LAM) is a rare disease of unknown etiology that occurs mainly in woman in her reproductive age. We recently experienced two cases of bilateral diffuse cystic lesion of the lung on chest X-ray and HRCT. The first case, a 26-year-old female, who had been diagnosed with tuberous sclerosis be the presence of clinical manifestation such as mental retardation, bilateral renal angiomyolipoma, adenoma sebaceum and generalized seizure, was admitted due to recently developed hemoptysis. Chest PA showed diffuse ground-glass opacity with radiolucent cystic lesions of various sizes on both lung fields. HRCT showed innumerable small cystic lesions with suspicious diffuse ground-glass opacity on both lung fields. The second case, a 30-year-old female was admitted due to dyspnea and spewing of blood-tinged sputum for 2 weeks, shortly after delivery. Chest PA showed diffuse reticular and ground-glass opacities on both lung field. HRCT showed multiple well-difined and relatively uniform size air cysts with a uniform wall thickness on entire both lung fields, with small amount of right pleural effusion. By thoracoscopic lung biopsy she was diagnosed with pulmonary lymphangioleiomyomatosis. We report these cases with a brief review of the literatures.
Adult ; Angiomyolipoma ; Biopsy ; Dyspnea ; Female ; Hemoptysis ; Humans ; Intellectual Disability ; Lung ; Lymphangioleiomyomatosis ; Pleural Effusion ; Rare Diseases ; Seizures ; Sputum ; Thorax ; Tuberous Sclerosis

Traumatic dislocation of the peroneus longus tendon is an often unrecognized injury which has been reported to occur most commonly during sports activity. Most acute cases with early detection can be treated by simple repair of the tendon or retinaculum using one of several procedures available. Accurate treatment through a comprehensive evaluation of the ankle injury prevents suboptimal and sometimes unrecorrectable outcomes. The authors experienced concomitantly the peroneus longus tendon dislocation associated with a trimalleolar fracture of the ankle. We report this case a brief review of the literature.
Animals ; Ankle ; Ankle Injuries ; Dislocations ; Sports ; Tendons

Inflammatory fibroid polyp is a relatively rare, benign polyp which is composed of fibraus connective tissue, blood vessels, and infiltration of eosinophils. The majority of inflammatory fibroid polyps has been reported with pathologic specimen in stomach and small intestine. We performed the gastrofiberscopy and endoscopic ultrasonogram of an inflammatory fibroid polyp, which reveals central ulcerated polypoid mass originated in the submucosa of antral portion of the stomach. So we report a case of endoscopic and endoscopic ultrasonographic findings of inflammatory fibroid piolyp in stomach. The etiolagy and pathology are discussed with the review of the literatures.
Blood Vessels ; Connective Tissue ; Eosinophils ; Intestine, Small ; Leiomyoma* ; Pathology ; Polyps* ; Stomach* ; Ulcer ; Ultrasonography

Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insect, wild or domestic animals or the environment. It is common in United States. An increasing number of cases have been reported from the Scandinavian countries, eastern Europe, Siberia, and Japan. But In Korea it has not been reported. A 40-year old male visited the department of Surgery on Jan 13, 1997 complaining multiple swollen lymph-nodes on his axillae and upper right arm for about ten days. On Dec 25, 1996, he found a dead wild rabbit at mountainside nearby, cooked it himself and ate it with his friends. He informed us that he got light injury on both hands while he was walking on the mountainside. On Dec 28, he started to suffer from high fever, fatigue and loss of appetite lasting for a day. After medication at a local clinic for several day, symptoms were somewhat relieved. A week later(Jan 4, 1997), several erythematous lesions developed on his both hands, which left ulcerations on the skin. Both axillary lymph nodes were swollen at both sides, but not tender. He visited the department of surgery on Jan 13 and he admitted on Jan 15. During hospitalization, the lymph nodes were surgically removed from both axillae and upper left arm. On microbiologic examination, small aerobic gram negative coccobacilli were grown on the chocolate agar plate in aerobic condition with 5% CO2 at 37 degrees centigrade. On Feb 10, fine needle aspiration from the liver abscess was done, drawing 3 ml of yellowish thick pustular material, but the microorganism was not isolated at the smear and culture of this material in the same condition as described above. After admission, he was treated with antibiotics(cefazole and marocin). His general conditions and laboratory results, including liver function, were markedly improved. He was discharged on Feb 12 and appears well on subsequent follow-ups. The microorganism and lymph nodes were sent to Centers for Disease Control and Prevention in the United States for further evaluation. A twostep indirect immunoalkaline phosphatase technique using an anti-F. tularensis antibody was performed on the lyph nodes having a positive reaction. The immunohistochemical stain demonstrated intense positivity in the stellate abscesses and fine granular reaction in some of the vessels in the paracortical region. Also F. tularensis was identified in the agar plug by culture morphology and immunofluorescence antibody test. We report a case of F. tularensis in Korea for the first time. Further studies were recommened for epidemiological characteristics and prevention of the disease.
Abscess ; Adult ; Agar ; Animals ; Animals, Domestic ; Animals, Wild ; Appetite ; Arm ; Axilla ; Biopsy, Fine-Needle ; Cacao ; Centers for Disease Control and Prevention (U.S.) ; Europe, Eastern ; Fatigue ; Fever ; Fluorescent Antibody Technique ; Follow-Up Studies ; Francisella tularensis ; Friends ; Hand ; Hospitalization ; Humans ; Insects ; Japan ; Korea* ; Liver ; Liver Abscess ; Lymph Nodes ; Male ; Siberia ; Skin ; Tularemia* ; Ulcer ; United States ; Walking