The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression.
Aged* ; Arthroscopy ; Decompression* ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Shoulder Joint ; Shoulder Pain ; Shoulder*

The purpose of this study was to evaluate the humeral tunnel characters and clinical relevance according to entry point of the humeral tunnel in the baseball players. It was hypothesized that the medial collateral ligament (MCL) reconstruction with nonanatomical starting location of the humeral tunnel (inferior edge of the medial epicondyle: group NA) provided less favorable radiological and clinical outcomes compared to that with anatomical starting location (original footprint of the MCL: group A). The retrospective case review yielded 19 consecutive athletes who underwent isolated MCL reconstruction using the docking technique. Three dimensional-computed tomography scan was performed at 3 months, and the iso-surfacing by marching cubes algorithm were applied to evaluate the length and angle of humeral tunnel. Three outcome measures were used in this study: the visual analog scale for pain, range of motion and the Conway scale. The angle of the humeral tunnel was measured 12.2° (range, 7.9°–25.2°) in the group NA and 15.5° (range, 9.8°–30.4°) in the group A (p<0.05). The mean length of humeral tunnel is measured 16.3 mm (range, 11.7–20.1 mm) in the group NA and 15.2 mm (range, 10.3–19.1 mm) in the group A (p<0.05). MCL reconstruction brought substantial improvement in pain and function. However, between-group comparison revealed no statistical differences in all outcome measurements. The MCL reconstruction using the docking technique provided favorable clinical outcomes in baseball players. Although the humeral tunnel angle and length were different depending on the humeral entry points, clinical differences between the two entry points were not found.
Athletes ; Baseball* ; Collateral Ligaments* ; Humans ; Outcome Assessment (Health Care) ; Range of Motion, Articular ; Retrospective Studies ; Visual Analog Scale

In adjustable strabismus surgery, a satisfactory final result would be achieved with delayed adjustment. However, the postoperative adhesions following strabismus surgery make delayed adjustment impossible. We evaluated the efficacy of mitomycin C in reducing the severity of postoperative adhesions following strabismus surgery and in delaying the time adjustment after surgery. Experimental rabbits underwent a hang-back recession procedure in the superior rectus muscle. A topical application of mitomycin C was made between the conjunctiva and the sclera for 5 minutes during the operation. We then studied the possible time of delayed adjustment and estimated the minimal forces required for the adjustment. The topical application of 0.1 mg/ml mitomycin C between the conjunctiva and sclera allowed for a 2-week delayed adjustment after surgery, and 0.2 mg/ml mitomycin C prevented the adhesions between these tissues and the muscle 5 weeks after surgery. These results suggest that topical mitomycin C may enhance the success rate of strabismus surgery with delayed adjustment and reduce postoperative adhesions.
Administration, Topical ; Animals ; Chemotherapy, Adjuvant ; Conjunctiva/drug effects ; Mitomycin/administration & dosage/*pharmacology ; Oculomotor Muscles/drug effects/pathology/*surgery ; Ophthalmic Solutions ; Postoperative Complications/prevention & control ; Rabbits ; Sclera/drug effects ; Strabismus/drug therapy/pathology/*surgery ; Suture Techniques ; Tissue Adhesions/prevention & control

OBJECTIVE: The pathologic diagnosis of the astrocytoma has been primarily based on the histologic grading, however, there are some discrepancies among the pathologists on the tumor grading. Met protein, known as the hepatocyte growth factor receptor, is a transmembrane 190 kDa heterodimer with tyrosine kinase activity, encoded by c-met gene. Although c-Met protein is known to be expressed in a variety of tissues and plays important roles in signal transduction, the study on its expression related to clinicopathological prognostic parameters in brain tumor is rare. METHODS: We have evaluated c-Met protein expression in association with p53 and Ki-67 expression in 35 astrocytic tumors (15 diffuse astrocytomas: LGA, 11 anaplastic astrocytomas: AA, 9 Glioblastoma multiforme: GBM) using immunohistochemical method. RESULTS: c-Met immunoreactivity was observed in 2 LGA(13.3%), 5AA(45.5%), 4GBM cases (44.4%), respectively. p53 immunoreactivity was observed in 2 LGA(13.3%), 4AA(36.4%), 4GBM cases (44.4%), respectively. Ki-67 labelling index was 1.7+/-1.0% (LGA), 13.3+/-.2% (AA) and 18.0+/-.1% (GBM), respectively. Each c-Met expression and the Ki-67 labelling index were statistically correlated between low grade and anaplastic astrocytomas. The c-Met and p53 expression rate were not associated with increased Ki-67 labelling index. But, c-Met, p53, Ki-67 expression tended to increase with higher grade of malignancy. CONCLUSION: We conclude that c-Met expression may contribute to the invasiveness and tumor progression of the astrocytoma and c-Met expression is useful in discrimination between low grade astrocytoma and anaplastic astrocytoma.
Astrocytoma ; Brain Neoplasms ; Diagnosis ; Discrimination (Psychology) ; Glioblastoma ; Neoplasm Grading ; Protein-Tyrosine Kinases ; Proto-Oncogene Proteins c-met ; Signal Transduction

The authors report a case of de novo right middle cerebral artery and left anterior cerebral artery aneurysms in a 52-year-old woman, which were documented angiographically 8 years after the initial left middle cerebral artery aneurysm rupture. She had a history of hypertension and had a familial intracranial aneurysm (her sister had a right A2 aneurysm and brother had a right middle cerebral artery bifurcation aneurysm. We conclude that postoperative follow-up cerebrovascular imaging study should be performed periodically with a more frequent cycle, especially in patients with familial intracranial aneurysms to rule out the subsequent development of de novo aneurysms.
Aneurysm ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Intracranial Aneurysm* ; Middle Aged ; Middle Cerebral Artery ; Rupture ; Siblings ; Subarachnoid Hemorrhage

OBJECTIVE: It is well known that hypotension and hypoxia are detrimental secondary brain insults and have deleterious effects on the outcome of patients with severe closed head injuries. We evaluated the effect of hypotension and hypoxia on aneurysmal subarachnoid hemorrhage(SAH). METHODS: We reviewed retrospectively 159 consecutive operated aneurysmal SAH cases. Hypotension and hypoxia were identified during the patients' operation and intensive care unit hospitalization. We analyzed them as four mutually exclusive categories: neither hypotension nor hypoxia(normal), hypotension only, hypoxia only, hypotension and hypoxia combined. The outcome following aneurysmal SAH was determined by the Glasgow outcome scale score and then analyzed. The incidence of occurrence of hydrocephalus and clinical vasospasm were also analyzed. RESULTS: 22 patients(13.8%) experienced hypotension and 16 patients(10.1%) experienced hypoxia and 8 patients(5.0%) experienced both hypotension and hypoxia. The incidence of hydrocephalus in combined category(75.0%) was significantly higher than normal category(14.3%). The incidence of clinical vasospasm in hypotension category(77.3%) and combined category(87.5%) were significantly higher than normal category(38.1%, p<0.05). The outcome of hypotension category and combined category were significantly unfavorable compared with normal category(p<0.05). Furthermore, the impact of hypotensive insult was much greater on good grade Hunt-Hess patients. CONCLUSION: The detrimental secondary brain insults as hypotension and hypoxia occurred not infrequently in aneurysmal SAH patients and had deleterious effects on the outcome of aneurysmal SAH patients. These data suggest that hypotension during critical period in aneurysmal SAH patients should be avoided to improve outcome.
Aneurysm* ; Anoxia* ; Brain ; Critical Period (Psychology) ; Glasgow Outcome Scale ; Head Injuries, Closed ; Hospitalization ; Humans ; Hydrocephalus ; Hypotension* ; Incidence ; Intensive Care Units ; Retrospective Studies ; Subarachnoid Hemorrhage*

BACKGROUND: Cardiopulmonary bypass (CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. MATERIAL AND METHOD: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava (MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm (GA), 1 for renal cell carcinoma (RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients (MOVC 4, GA 1, RC 1). RESULT: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26degree C on average in MOVC, and 19degree C in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients (malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found. CONCLUSION: Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.
Aneurysm ; Carcinoma, Renal Cell ; Cardiopulmonary Bypass* ; Edema ; Embolectomy ; Extremities ; Hematoma ; Hemodynamics ; Humans ; Hypothermia ; Liposarcoma ; Lung Transplantation ; Melanoma ; Neurologic Manifestations ; Pulmonary Embolism ; Reoperation ; Seoul ; Sepsis ; Thoracic Surgery ; Vena Cava, Inferior

We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion.
Arteries* ; Coronary Angiography ; Coronary Artery Bypass ; Embolization, Therapeutic ; Humans ; Mammary Arteries* ; Myocardial Ischemia* ; Perfusion ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon ; Transplants*

Necrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively. The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.
Emergencies ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Muscles ; Orthopedics ; Rectal Neoplasms ; Thigh

We experienced a case of 63 years old male patient who had synchronous rectus abdominis intramuscular schwannoma and chest wall lipoma. Schwannoma is rare benign tumor which derived from nerve sheath and mainly peripheral nerve of flexor part. The authors report rare synchronous schwannoma and lipoma development.
Humans ; Lipoma* ; Male ; Neurilemmoma* ; Peripheral Nerves ; Rectus Abdominis* ; Thoracic Wall ; Thorax*