The finger flexor injuries are very difficult to treat satisfactorily. It is usually said that the earlier the treatment performed, the better result obtained. But the delicasy of the hand anatomy and its function as well as the absence of the hand surgeon in the first aid care make the problem more complex. Even if we made the primary treatment to the flexor tendon injuries, some disabilities are often remained. We have treated fifty eight cases of old flexor tendon injuries in forty eight patients, the results can be summarized as follows. 1. The cause of the tendon damage is due to the laceration injury in the majorities of the cases. T,he tendon injuries are especially common between the late second and the early third decade. 2. In the injury of the Zone II with pulley distortion, the pulley reconstruction using palmaris longus or fascia from other sites will prevent bowstring and help the tendon function. 3. The Zone II can be subdivided into two subspecific areas. The proximal area is from the distal palmar crease to the midoprtion of porximal phalanx and the distal one is from the midportion of the proximal phalanx to the insertion of the sublimis tendon. In the proximal area one can repair the injured tendon directly after removal of the A1 and about proximal half of the A2 pulley without any subsequent bowstring if the tendon and its tunnel is relatively well preserved. Thus one can convert this proximal portion of Zone II to Zone III. So the proximal area of the Zone II should be differentiated from the remaining distal part of the Zone II. 4. At six months after the operation the result of the operation was analyzed by the percentage of the recovery, which was calculated by the postoperative active range of the interphalangeal joints divided by one hundred seventy five degrees that means the available total range of motion of normal interphalangeal joints. Excluding the cases with the tenodesis or arthrodesis, the total result revealed good or excellent in about ninty percentages with this method. 5. There were two fingers that showed a postoperative lumbrical plus state in Zone II, which were recovered spontaneously within three to four months postoperatively. So it is considered that the relative shortening of the lumbrical muscles can be treated and overcome conservatively by the active use of the fingers, and there is no need to perform an lumbrical tenotomy to correct this kind of muscle imbalance.
Arthrodesis ; Fascia ; Fingers ; First Aid ; Hand ; Humans ; Joints ; Lacerations ; Methods ; Muscles ; Patella ; Patellar Ligament ; Range of Motion, Articular ; Tendon Injuries ; Tendons ; Tenodesis ; Tenotomy ; Tibia

Barraquer-Simmons syndrome, also known as cephalothoracic lipodystrophy, is an uncommon disorder of unknown origin. Patients with this syndrome lose their subcutaneous fat of face and it progresses to the thoracic region. Simultaneously, the accumulation of subcutaneous fatty tissue in lower extremity occurs. The onset of this syndrome is known to be in their teens and patients are mainly female. The progression of this condition stops spontaneously in their early twenties. Twenty percents of patients show nephropathy with complement disorder which aggravates the prognosis. We present a 34-year-old female with typical features of this syndrome. This patients was treated with autologous free fat graft harvested from the gluteal area. The donor and recipient site healed uneventfully and the result was comparatively satisfactory. Autologous fat graft method is easy to perform, allows fast recovery with minimal donor site morbidity and is a useful method for the patients with Barraquer-Simmons syndrome.
Adipose Tissue ; Adolescent ; Adult ; Complement System Proteins ; Female ; Humans ; Lipomatosis, Multiple Symmetrical ; Lower Extremity ; Prognosis ; Subcutaneous Fat ; Tissue Donors ; Transplants*

Using KAIS 0.15 Tesla magnetic resonance imaging system, ECG gated magnetic resonance image (MRI) of cardiovascular system was obtained in 8 normal volunteers and 10 patients with various cardiovascular diseases diagnosed at Seoul National University Hospital. The findings of cardiovascular MRI were analysed and the results were as follows ; 1) ECG gated MRI revealed datailed normal anatomy of heart including both atrioventricles and great vessels in axial, sagittal and coronary sections with natural contrast of moving blood without contrast media. 2) Dynamic changes of both ventricular walls in systolic and diastolic phase were revealed in sequential axial MRI, and increased signals were detected in left ventricle and descending aorta due to slow flow in end diastole. 3) Left ventricular aneurysm and myocardial thinning were shown in 2 cases of myocardial infarction. Enlarged left atrium was noted in 1 cases of mitral stenosis. Segmental analysis was possible in 3 cases of corrected transposition of great vessels. 4) Enlarged lumen, intimal flap and irregular luminal narrowing were detected in each of ascending aortic aneurysm, dissecting aneurysm and Takayasu's arteritis respectively. Pericardial effusion due to lymphoma revealed low signal encircling heart in contrast with neighboring mediastinal structures and cardiac wall. 5) MRI is a new promising modality in the diagnosis of cardiovascular system, which has potentiality to give a hemodynamic information in addition to the anatomical detalis.
Aneurysm ; Aneurysm, Dissecting ; Aorta, Thoracic ; Aortic Aneurysm ; Cardiovascular Diseases ; Cardiovascular System* ; Contrast Media ; Diagnosis ; Diastole ; Electrocardiography ; Healthy Volunteers ; Heart ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Mitral Valve Stenosis ; Myocardial Infarction ; Pericardial Effusion ; Phenobarbital ; Seoul ; Takayasu Arteritis ; Transposition of Great Vessels

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
Adult ; Cerebral Infarction ; Female ; Humans ; International Classification of Functioning, Disability and Health ; Lupus Erythematosus, Systemic ; Lupus Vasculitis, Central Nervous System* ; Peripheral Nervous System ; Polyneuropathies ; Posterior Leukoencephalopathy Syndrome ; Quality of Life ; Rehabilitation*

BACKGROUND/AIMS: Interferon beta (IFN-beta) has been shown to have antiviral activity, and thus could be useful in treating viral infections. Therefore, we compared the efficacy and safety of recombinant IFN-beta(IFN-beta-1a) plus oral ribavirin versus interferon alpha (IFN-alpha) plus ribavirin therapy for the treatment of chronic hepatitis C (HCV). METHODS: Twenty treatment-naive patients were randomized into two equal-sized treatment groups. Both IFN-beta-1a (44microgram) and IFN-alpha (3 MIU) were given subcutaneously three times a week, while ribavirin was given orally at 1,000-1,200 mg/day. Patients were treated for 24 weeks and followed for an additional 24 weeks. RESULTS: After 24 weeks of treatment, six (60%) and four patients (40%) in the IFN-beta-1a group and IFN-alpha groups, respectively, achieved viral clearance. The sustained virological response (SVR) at the end of the observation period was similar in both groups (40%). However, the baseline viral load was significantly higher (p=0.034) in the IFN-beta-1a group than in the IFN-alpha group, and there were more HCV genotype 1 patients in the IFN-beta-1a group (eight versus seven). The IFN-beta-1a group was associated with similar adverse events in terms of frequency and severity. CONCLUSIONS: The SVR rate and safety profile were similar for the combination of IFN-beta-1a and ribavirin and that of IFN-alpha and ribavirin.
Genotype ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Interferon-alpha ; Interferon-beta ; Interferons ; Pilot Projects ; Prospective Studies ; Ribavirin ; Treatment Outcome ; Viral Load

Purpose: We investigated the feasibility of using an anatomically localized, target-enriched liquid biopsy (TLB) in mouse models of lung cancer. Materials and Methods: After irradiating xenograft mouse with human lung cancer cell lines, H1299 (NRAS proto-oncogene, GTPase [NRAS] Q61K) and HCC827 (epidermal growth factor receptor [EGFR] E746-750del), circulating (cell-free) tumor DNA (ctDNA) levels were monitored with quantitative polymerase chain reaction on human long interspersed nuclear element-1 and cell line-specific mutations. We checked dose-dependency at 6, 12, or 18 Gy to each tumor-bearing mouse leg using 6-MV photon beams. We also analyzed ctDNA of lung cancer patients by LiquidSCAN, a targeted deep sequencing to validated the clinical performances of TLB method. Results: Irradiation could enhance the detection sensitivity of NRAS Q61K in the plasma sample of H1299-xenograft mouse to 4.5- fold. While cell-free DNA (cfDNA) level was not changed at 6 Gy, ctDNA level was increased upon irradiation. Using double-xenograft mouse with H1299 and HCC827, ctDNA polymerase chain reaction analysis with local irradiation in each region could specify mutation type matched to transplanted cell types, proposing an anatomically localized, TLB. Furthermore, when we performed targeted deep sequencing of cfDNA to monitor ctDNA level in 11 patients with lung cancer who underwent radiotherapy, the average ctDNA level was increased within a week after the start of radiotherapy. Conclusion TLB using irradiation could temporarily amplify ctDNA release in xenograft mouse and lung cancer patients, which enables us to develop theragnostic method for cancer patients with accurate ctDNA detection.

Legionella species are causative agents of both community-acquired and nosocomial pneumonia. The spectrum of disease ranges from asymptomatic infection to serious disease and two specific syndromes are identified, i.e., Legionnaires' disease and Pontiac fever. Legionnaires' disease tends to occur in patients with underlying illnesses, so Legionella pneumonia should be included in the differential diagnosis of severe community-acquired pneumonia, especially in immunocompromised patients. Herein we report a case of community- acquired Legionnaires' disease in a patient with renal transplantation. A 63-year old man was admitted because of fever, chills, and dyspnea. Thirteen years ago, he had undergone kidney transplantation and he had received immu-nosuppressive agents, including deflazacort and cyclosporin A. On physical examination crackles were heard in the middle area of the right lung and the chest radiograph showed multifocal patchy consolidations on both lung fields. Serologic tests for Legionella pneumophila antibody, urinary antigen assay for L. pneumophila serogroup 1, and polymerase chain reaction for Legionella DNA fragments (5S rRNA, IPC, mip target sequence) were positive. The patient was treated with roxithromycin for twenty eight days and recovered without complication.
Asymptomatic Infections ; Chills ; Cyclosporine ; Diagnosis, Differential ; DNA ; Dyspnea ; Fever ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Legionella ; Legionella pneumophila ; Legionnaires' Disease* ; Lung ; Middle Aged ; Physical Examination ; Pneumonia ; Polymerase Chain Reaction ; Radiography, Thoracic ; Respiratory Sounds ; Roxithromycin ; Serologic Tests ; Transplantation*

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus. METHODS: Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated 'control group' (n=17) and 'treated group' (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed. RESULTS: The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out. CONCLUSIONS: Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate.
Adolescent ; Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*pathology/*therapy ; Combined Modality Therapy ; Female ; *Heart Atria/pathology ; Heart Diseases/*etiology ; Humans ; Liver Neoplasms/mortality/*pathology/*therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Thrombosis/*etiology ; Treatment Outcome ; *Vena Cava, Inferior/pathology

BACKGROUND/AIM: We identified risk factors for hepatocellular carcinoma (HCC) through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver diseases. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. METHODS: We studied a total of 994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. RESULTS: 90 (9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into three groups by their risk index and probability of HCC development. These patients were classified into a low risk group (less than 5% probability), an intermediate risk group (5% to 10% probability), and a high risk group (more than 10% probability). According to this classification, 1 of 191 patients in the low risk group (0.523%), 5 of 176 patients in the intermediate risk group (2.84%), and 21 of 113 patients in the high risk group (18.6%) were diagnosed with HCC. CONCLUSION: We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Humans ; Korea* ; Liver Diseases ; Logistic Models ; Mass Screening ; Risk Factors*

BACKGROUNDS/AIMS: The relationship between HBV infection and nephropathy has been reported with some differences according to the investigators and regions studied. Liver biopsies were not performed in most of the reports. In this study both liver and kidney biopsies were performed. The histologic correlation was analyzed between chronic B viral hepatitis and nephropathy. METHODS: From January 1985 to June 2000, both liver and kidney biopsies were performed on 26 patients who had chronic hepatitis B, proteinuria, and hematuria. Also, a new histopathologic classification of chronic hepatitis was applied in the assessment of liver disease. RESULT: Light microscopy of kidneys showed IgA nephropathy in 7 cases (27%); minimal change nephrotic syndrome (MCNS) in 1 case (3.8%); and membranous glomerulonephritis (MGN) in 9 cases (34.6%), membranoproliferative glomerulonephritis (MPGN) in 9 cases (34.6%). Among the cases with a higher hepatitis activity index and fibrosis score, the frequency of MGN and MPGN was higher. The hepatitis activity index of cases with MGN was significantly higher than IgA nephropathy and MPGN (p=0.011, p=0.039). The fibrosis score of cases with MGN and MPGN was significantly higher than IgA nephropathy (p=0.011, p=0.003). The positivity of HBeAg was highest in cases with MGN. Serum C3 level was low in all cases but the serum C4 level was within normal range. Immunofluorescence studies showed granular deposition of IgG and C3 in the capillary loops in MGN. CONCLUSION: The frequency of MGN and MPGN was higher when the liver disease was more severe. It was suggested that HBeAg, IgG and C3 might contribute to the pathogenesis of MGN in HBsAg positve patients.
Biopsy ; Capillaries ; Classification ; Fibrosis ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunoglobulin G ; Kidney ; Liver ; Liver Diseases ; Microscopy ; Nephrosis, Lipoid ; Proteinuria ; Reference Values ; Research Personnel