We reviewed 40 cases of femoral shaft fractures in children treated with split Russel traction and initial fracture angulation above 10 degree. The treatment of femoral shaft fractures in children is various according to age. Satisfactory results have been reported with split-Russel traction. At an average follow-up of 33 months, we obtained following results about remodelling of fracture site & physeal site, possible acceptable angulation of fracture. 1. The average time of traction was 18 days, and hip spica cast was applied for 28 days. 2. Malunion within 25degrees in flexion & 23degrees in valgus & 24degrees in varus was well corrected spontaneously. 3. Average correction of initial angular deformity was 86% at last follow up. 4. Anterior angulation was corrected at 83%, varus 87%, valgus 88%. 5. Remodelling according to direction of deformity was no statistical correlation (P>0.05), and then spontaneous correction of angular deformity was same without relation to direction of deformity. 6. Remodelling according to site was statistical correlation (P<0.05), fracture site 26%, physes 74%. And proximal physes 36%, distal physes 38%.
Child* ; Congenital Abnormalities* ; Follow-Up Studies ; Hip ; Humans ; Traction*

Aneurysmal bone cyst uncommonly involves the pubic bone and tends to grow eccentrically and thin out overlying cortex. In the following case report, a 19-year-old male patient visited out hospital, because of dull pain in his left groin. He was diagnosed as aneurysmal bone cyst originated from the superior pubic ramus by CT guided needle biopsy. Transcatheter arterial embolization was effective in the treatment of this lesion such as complete consolidation after the procedure. At present, 2 years follow-up, no problem was noted at weight bearing as well as hip function or recurrence.
Aneurysm ; Biopsy, Needle ; Bone Cysts ; Follow-Up Studies ; Groin ; Hip ; Humans ; Male ; Pubic Bone ; Recurrence ; Weight-Bearing ; Young Adult

OBJECTIVE: This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. METHODS: Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. RESULTS: Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. CONCLUSION: Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor.
Brachial Plexus ; Female ; Granular Cell Tumor ; Humans ; Hypesthesia ; Male ; Medical Records ; Nerve Sheath Neoplasms ; Neurilemmoma ; Neurofibroma ; Neurofibromatoses ; Peripheral Nerves ; Retrospective Studies

Treatment of Rupture of Achilles tendon was first reported by Pare, 1575 and thereafter the various causes, diagnostic & therapeutic method of the ruptured tendon have been described by many authors. The two options of treatment are conservative management and surgical treatment and currently surgical intervention has been more popular. There are various surgical techniques which have been reported by many surgeons to treat the acute rupture of the Achilles tendon. In this report, 18 cases ( 11 male & 7 female ) of injuried Achilles tendon had been treated by the modified Lindholm method and follow-up study of 18 cases had been made during 28 months from august. 1993 to december, 1995. The results as follows; 1. After repair by the modified Lindholm method, a long leg cast was applied, and then aweight bearing was started average 8 weeks postoperatively. It can be demonstrated to shorten hospitalization and early ambulation compared to other surgical techniques 2. Postoperative power of triceps surae muscle was improved to normal in 15 patients ofthe 18 patients, and muscle power was good in 3 patients, but, all cases was improved to nearly normal whithin the last follow up. 3. Heel to floor distance was 0.6cm less on the operated side than on the normal side, and the difference decreased to 0.2cm at the last follow up. 4. The calf atrophy was minimal, and active range of motion of ankle was within normal limit. 5. We suggest that the procedure is recommended for one of the methods of the treatment of acute rupture of the Achilles tendon, because it is easy to do and permits early weight bearing and the complication is less.
Achilles Tendon* ; Ankle ; Atrophy ; Early Ambulation ; Female ; Follow-Up Studies ; Heel ; Hospitalization ; Humans ; Leg ; Male ; Range of Motion, Articular ; Rupture* ; Tendons ; Weight-Bearing

It is important to follow strict indications for surgery and recognize prognostic factors in order to get good results in the surgical treatment of herniated nucleus pulposus. 55 patients with herniated nucleus pulposus were studied who had had laminectomy and discectomy and were followed up for more than 1 year in order to analyze the correlation between various factors including history, physical examination and radiologic finding and surgical results. Age, sex, symptom duration, location of the herniation, smoking, occupation, physical examination, disc height change, MRI findings, operation time and bleeding volume were evaluated as prognostic factors that seemed to influence surgical result. The results are as follow 1. Female had significantly better surgical results than male (P<0.05). 2. Non-smokers had significantly better surgical result than smokers (P<0.01). 3. In MRI finding, protruded disc had significantly better surgical result when it had involved spinal canal posterolaterally than centrally (P<0.01). 4. The less bleeding volume, the better surgical result (P<0.05).
Diskectomy ; Female ; Hemorrhage ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Occupations ; Physical Examination ; Smoke ; Smoking ; Spinal Canal

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.
Albendazole/*adverse effects ; Antiprotozoal Agents/*adverse effects ; Eosinophils/metabolism ; Glucose/metabolism ; Hepatitis, Toxic/*diagnosis ; Humans ; Liver/drug effects ; Liver Function Tests ; Male ; Middle Aged ; Necrosis

Most malignant tumors originating from the biliary tract are adenocarcinomas, and adenosqamous carcinoma of Klatskin's tumor is a very rare finding. An 83-yr-old man was admitted to our hospital because of jaundice. The abdominal computed tomography and magnetic resonance cholangiopancreatography revealed wall thickening and luminal stenosis of both the intrahepatic duct confluent portion and the common hepatic duct. These findings were compatible with Klatskin's tumor, Bismuth type III. Considering the patient's old age, palliative combined modality therapy was performed. After percutaneous transhepatic biliary drainage, biopsy was performed via percutaneous transhepatic cholangioscopy. The histopathologic findings showed adenosquamous carcinoma. External radiotherapy and intraluminal brachytherapy through the endobiliary Y-type stent were then done. Nine months after the radiotherapy, the laboratory findings and the abdominal computed tomography revealed biliary obstruction and progressive hepatic metastasis. The combined modality therapy of external radiotherapy, intraluminal brachytherapy and stenting assisted him to live a normal life until he finally experienced biliary obstruction.
Aged, 80 and over ; Bile Duct Neoplasms/*diagnosis/therapy ; *Bile Ducts, Extrahepatic ; Carcinoma, Adenosquamous/*diagnosis/therapy ; Cholangiography ; Combined Modality Therapy ; Humans ; Jaundice/etiology ; Male ; *Palliative Care ; Stents ; Tomography, X-Ray Computed

OBJECTIVES: The aim of this study was to investigate the expression of 7 different sirtuin genes (SIRT1-SIRT7) in human dental pulp cells (HDPCs), and to determine the role of SIRTs in the odontoblastic differentiation potential of HDPCs. MATERIALS AND METHODS: HDPCs were isolated from freshly extracted third molar teeth of healthy patients and cultulred in odontoblastic differentiation inducing media. Osteocalcin (OCN) and dentin sialophosphoprotein (DSPP) expression was analyzed to evaluate the odontoblastic differentiation of HDPCs by reverse transcription-polymerase chain reaction (RT-PCR), while alizarin red staining was used for the mineralization assay. To investigate the expression of SIRTs during odontoblastic differentiation of HDPCs, real time PCR was also performed with RT-PCR. RESULTS: During the culture of HDPCs in the differentiation inducing media, OCN, and DSPP mRNA expressions were increased. Mineralized nodule formation was also increased in the 14 days culture. All seven SIRT genes were expressed during the odontogenic induction period. SIRT4 expression was increased in a time-dependent manner. CONCLUSIONS: Our study identified the expression of seven different SIRT genes in HDPCs, and revealed that SIRT4 could exert an influence on the odontoblast differentiation process. Further studies are needed to determine the effects of other SIRTs on the odontogenic potential of HDPCs.
Dental Pulp* ; Dentin ; Gene Expression* ; Humans* ; Molar, Third ; Odontoblasts* ; Osteocalcin ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Tooth

Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.
Acetabulum ; Adult ; Aged ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Femur ; Humans ; Immunotherapy ; Magnetic Resonance Imaging ; Melanoma* ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thigh ; Urinary Bladder ; Uterine Cervical Neoplasms ; Uterine Hemorrhage ; Vagina*

Primary malignant melanoma (MM) accounts for 1% of all cancers, and only 3% to 7% of these tumors occur in the female genital tract. Data are limited with respect to the basis for treatment recommendations because of the rarity of MM. The overall prognosis of melanomas of the female genital tract is very poor. Two cases of MM of the female genital tract are presented. The first case is of a 70-year-old female patient who complained of left thigh pain and underwent magnetic resonance imaging that showed cervical cancer with involvement of the vagina, bladder, and parametrium, in addition to multiple bony metastases of the proximal femur, acetabulum, and both iliac bones. The second case is of a 35-year-old female patient who suffered from vaginal bleeding for 5 months, and she was diagnosed as having primary vaginal melanoma. The patient underwent radical surgery and two additional surgeries because of recurrence of cancer in both inguinal areas. After surgery, the patient received adjuvant immunotherapy, radiation therapy, and chemotherapy. In both the aforementioned cases, the pathologic diagnosis was made after immunohistochemical analysis, i.e., the tumor cells were stained with HMB-45 and S100, and were found to be positive for both immunostains.
Acetabulum ; Adult ; Aged ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Femur ; Humans ; Immunotherapy ; Magnetic Resonance Imaging ; Melanoma* ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thigh ; Urinary Bladder ; Uterine Cervical Neoplasms ; Uterine Hemorrhage ; Vagina*