Fracture of the tibial shaft is the most common fracture of the long bones, and due to its frequency, mode of injury and sometimes type of treatment, has become a major source of permanent and temporary disability. The treatment of fractures of the tinial shaft has become one of the most controversial subjects in orthopedic surgery. Recently flexible intramedullary nails have been used successfully in treatment of fractures of the tibial shaft. In this paper we are reporting our experience with the method in 29 selected fractures of the tibia in 28 patients. The results were as follows. l. Of 29 cases, 19 cases were male and 10 cases were female. The average age was 33.4 years and the most common cause of injury was traffic accident. 2. Seventeen cases were closed fractures and twelve cases were open fractures. Nineteen cases were comminuted fracture. The most common level of the fracture was middle third of the tinial shaft. 3. Average interval from injury to Ender nailing was 10.3 days and the mean duration of permmit to full weight bearing was 9.8 weeks. 4. The mean duration of clinical bone union was 10.2 weeks and that of roentgenological bone union was 17.8 weeks. 5. 9 cases of complication were noted among the 29 cases of tibial shaft fracture which was treated by Ender nsiling such as angulation, ankle joint stiffness, and one case of delayed union. 6. Ender nailing are relative ease of nailing, allow early weight bearing and decrease complication. So Ender nailing is considered to be a good methods in treating tibial shaft fracture.
Accidents, Traffic ; Ankle Joint ; Female ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Humans ; Male ; Methods ; Orthopedics ; Tibia ; Weight-Bearing

Chordoma is relatively rare and slowly growing tumor arising from notochordal remnant. The tumor is locally infiltrative rather than metastatic. Distant metastasis occured in 5% of Gentil & Coley's cases and 43% of Higinbotham et als cases. Usual sites of metastasis sites were lung, liver adrenal gland and lymph nodes. In 1922, Stewart reported first case of extrapulmonary metastatic chordoma in muscle & subcutaneous layer, which was extremely rare. We have experienced a case of wide spread multiple metastasis to muscle & subcutaneous tissue from primary sacrococcygeal chordoma. The case was 26 years old man, who have had multiple metastatic lesions in trunk, upper & lower extremities. They located in muscle and subcutaneous fat layer. In some lesions neurovascular structure was involved. We have treated the metastatic lesions by complete surgical excision, and they were confirmed as soft tissue chordoma by histologic examination.
Adrenal Glands ; Chordoma ; Liver ; Lower Extremity ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Notochord ; Subcutaneous Fat ; Subcutaneous Tissue

PURPOSE: This study compared the sequential findings of ultrasound, MRI and tissue specimen radiograms of experimentally induced fat necrosis in pigs with the histopathology findings. MATERIALS AND METHODS: Fat necrosis was induced in five experimental groups containing three pigs per group (3-day, 2-week, 4-week, 6-week and 8-week groups), which were divided according to the amount of time after inducing fat necrosis until when the tissue specimen was obtained. Ultrasound (US) and MRI (T1 weighted images, T2 weighted images, STIR sequence, T1 fat-suppressed contrast enhanced images) were obtained. X-ray tissue specimen radiograms were obtained after sacrificing the pigs. The changes in the findings of these imaging modalities were compared with the histopathology findings. RESULTS: Ultrasound showed the lipase-induced masses of fat necrosis to be isoechoic (47%) and mixed echoic (42%) masses in 3-day group, mixed (56%, 41%) and hypoechoic (42% and 59%) masses in the 2-week and 4-week groups respectively, and hypoechoic (67% and 56%) masses in the 6-week and 8-week groups. MRI showed the T1 weighted images to have significantly high rate of isosignal intensity in the 3-day, 2, 4 and 6-week groups, but the isosignal intensity lesions decreased gradually while the low signal intensity lesions increased with time. The T2 weighted images showed that the high signal intensity lesions were the main type of lesion in the early stage but the isosignal intensity lesions increased markedly in the late stage. The STIR (short tau inversion recovery) sequence showed that all the masses of fat necrosis were observed to have high signal intensity in the 3-day group, and the high signal intensity lesions decreased while the isosignal intensity lesions increased significantly during the follow-up period between 2 weeks to 8 weeks. All the masses of fat necrosis were enhanced on the fat-suppressed contrast-enhanced T1 weighted images. Among the total 45 cases X-ray tissue specimen radiograms, fat necrosis was observed as a radiopaque mass in 28 cases (62%). Among these 28 cases, calcifications within the masses were observed in 4 cases from the 8-week group and 1 case from 6-week group. Two cases from 2-week group were observed as spiculated masses. The histopathology findings of fat necrosis were acute inflammatory cell infiltration, edema and hemorrhage in the 3-day group, the proliferation of fibroblasts, connective tissue and capillaries around the fat necrosis in the 2-week group. However, the number of vessels decreased gradually and the fibrosis had progressed further in the 4, 6 and 8-week groups. CONCLUSION: The sequential findings of fat necrosis on US, MRI and tissue specimen radiogram were correlated with the histopathology findings. These results may be helpful for the differentiating fat necrosis from more ominous breast masses.
Breast ; Capillaries ; Connective Tissue ; Edema ; Fat Necrosis* ; Fibroblasts ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Magnetic Resonance Imaging* ; Swine* ; Ultrasonography

The increase in size of lymph node on Ct scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and locations. The duration of symptoms, and the extent and patterns of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were larger than 1-1.5cm. The prevalence of mnode enlargement increased significantly with a longer duration of symptom (p=0.001), larger extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.0344). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of nodes enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern.
Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Diseases ; Lymph Nodes* ; Lymphatic Diseases ; Prevalence ; Tomography, X-Ray Computed*

PURPOSE: To evaluate characteristic MR findings of craniocerebral anomaly and its relationship with neurologic manifestations. MATERIALS AND METHODS: We retrospectively reviewed MR images of 36 patients with craniocerebral anomaly diagnosed by MRI and clinical courses. We correlated the characteristic MR findings in 41 lesions with neurologic manifestastions focusing on seizures and developmental delay. RESULTS: Twenty-three patients with seizures consisted of 14 patients(60%) with neuronal migration disorders and seven(30%) with phakomatosis, among which 18 patients(78%) had generalized type of seizures. Locations of the lesions were the parietal lobes in 11 patients(52%) and the subependymal or periventricular regions in seven(33%). Two patients with tuberous sclerosis had the lesions in both parietal and subependymal areas. Nine patients had the signs of developmental delay that were seen in the four(44%) with schizencephaly, two (22%) with tuberous sclerosis, two(22%) with heterotopia, and one(ll %) with pachygyria. CONCLUSION: Neuronal migration anomaly was relatively common lesion that presented neurologic manifestations such as seizures and developmental delay. Generalized type of seizures was common. We were able to diagnose these anomalies using the MRI that helped establish therapeutic plans.
Humans ; Lissencephaly ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Neurocutaneous Syndromes ; Neurologic Manifestations ; Neuronal Migration Disorders ; Neurons ; Parietal Lobe ; Rabeprazole ; Retrospective Studies ; Seizures* ; Tuberous Sclerosis

BACKGROUND: The purpose of this study was to investigate the prognostic significance of the Epstein-Barr virus (EBV) infected non-neoplastic lymphocytes in patients with Hodgkin lymphoma (HL). METHODS: Seventy-seven cases of HL were evaluated by immunohistochemical analysis and EBV-encoded RNA in situ hybridization. The cases were divided into three groups according to the EBV status. EBV was negative in 48 cases (group 1), EBV was located in the Hodgkin/Reed-Sternberg (HRS) cells, but not in the non-neoplastic lymphocytes in 20 cases (26%) (group 2) and EBV was located in both the HRS cells and the non-neoplastic lymphocytes in 9 cases (12%) (group 3). RESULTS: The groups differed with respect to the age distribution, the clinical presentation and the prognosis. The median ages were 30 (group 1), 47.5 (group 2) and 23 years (group 3) (p = 0.011). B symptoms (p = 0.007) and the histologic subtype of mixed cellularity classical HL (p = 0.001) were more common in the EBV-positive patients than in their EBV-negative counterparts. Two patients from group 3 had associated chronic EBV infection syndrome. The five-year survival rate was 97.56% in group 1, 75.76% in group 2 and 100% in group 3 (p = 0.0178). CONCLUSIONS: HL with EBV located in both the HRS cells and the non-neoplastic lymphocytes is a distinct prognostic subgroup that has better survival than the HL with EBV located in only the HRS cells.
Age Distribution ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Hodgkin Disease ; Humans ; In Situ Hybridization ; Lymphocytes ; Prognosis ; RNA ; Survival Rate

BACKGROUND: Diffuse panbronchiolitis(DPB) is a chronic inflammatory disease affecting the respiratory bronchioles which was first described in Japan in 1966. DPB is prevalent in Japan and is known to be very rare in western countries. The first cases of DPB were reported in Korea in 1992 and the number of the patients has been increasing. The prognosis of DPR had been very poor because there had been no effective treatment for the disease. Hut it has been dramatically changed since the introduction of low-dose long-term erythromycin therapy. In Korea, there is rare experience of 1ong-term follow-up of DPH patients and we presents the results of mean 21.6 months of follow-up after erythromycin treatment. METHODS: We analyzed the long-term follow-up data of 25 DPH patients who were diagnosed in Seoul National University Hospital during the period from September 1989 to December 1994 and followed up more than 6 months with erythromycin therapy. We tried erythromycin 250mg b.i.d. on all the patients and analyzed the changes of subjective symptoms, physical signs, pulmonary function tests, and chest X-rays. RESULTS: 1) The mean follow-up period was 21.6 months. 2) Subjective symptoms improved in 96% of the patients within 3 months and 76% of the patients showed no symptom after 18 months of treatment. 3) Crackles and wheezing decreased in all patients within 3 months and completely disappeared in 76% of the patients after 18 months of treatment. 4) Diffuse small nodular lesions on chest X-ray decreased in 56% of the patients within 3 months and chest PA was normal in 32% of the patients after 12months of treatment. 5) FVC and FEV1 increased remarkably during the first 3 months and slowly increased thereafter, reaching normal level after 12 months of treatment. FEV1/FVC was 60.4% before treatment and in- creased slowly reaching 76.1% after 24 months of treatment. 6) Erythromycin therapy could be finished in 7 patients. The mean duration of medication was 26 months and no evidence of recurrence was found in 6 months of follow-up. 7) No patients had experienced the side effect of erythromycin, CONCLUSION: The prognosis of DPR is very goad when treated with erythromycin. And at least 2 years of erythromycin treatment seems to be needed for DPB patients.
Bronchioles ; Erythromycin* ; Follow-Up Studies* ; Humans ; Japan ; Korea ; Prognosis ; Recurrence ; Respiratory Function Tests ; Respiratory Sounds ; Seoul ; Thorax

BACKGROUND AND OBJECTIVES: Many studies report using various agents to reduce morbidity of post-tonsillectomy. Steroid, for example, is often given to decrease postoperative morbidity. This study was designed to determine the efficacy of the intraoperative topical injection of steroid into the pillar and tonsillar bed. SUBJECTS AND METHOD: Eighty patients aged between 15 to 30 years were randomly divided into two groups: 40 patients (Group I) received a single intraoperative dose of topical dexametha-sone sodium phosphate, whereas the control group was given normal saline. After the operation, each patient was evaluated for pain, oral intake, use of analgesics. RESULTS: There were no statistically significant differences noted in pain score, oral intake, use of analgesics among the two groups of patients. CONCLUSION: From the post operative day 1 to post operative day 7, dexamethasone sodium phosphate may play a limited role in the patient recovery from tonsillectomy. The results showed that a single dose of the topical dexamethasone sodium phosphate did not affect the postoperative morbidity.
Analgesics ; Dexamethasone ; Humans ; Sodium ; Steroids ; Tonsillectomy

PURPOSE: Gastric variceal bleeding in cirrhotic patient is an emergent, life threatening disease of which the adequate treatment is still in dispute. The periesophagogastric devascularization (PD) would be the alternative operative procedure. The aim of this study is to evaluate the safety and long-term results of PD for the gastric fundal variceal bleeding. METHODS: A retrospective analysis was made of fifty-two patients with gastric variceal bleeding who underwent PD with or without fundectomy from August 1994 to March 2006. We evaluated the clinical characteristics, operative morbidity, mortality and long-term follow up results. RESULTS: The operative morbidity was 34.9% and overall mortality was 17.3%. The Child-Pugh classification at operation, the number of previous varix bleeding episode, the success of preoperative intervention, splenectomy, esophageal transection, and ongoing bleeding at operation had a significant effect on postoperative mortality. Most common cause of postoperative death was hepatic failure. Child-Pugh classification and esophageal transection were significant risk factor for postoperative mortality comparing before and after year 2001. During the mean follow-up period of 33.58+/-27.08 months, there was no recurrent bleeding from gastric varices. The cumulative 5-year survival rate was 64.1%. 0f 14 patients deceased, 6 patients died of hepatocellular carcinoma. Not only there was no death caused by recurrent variceal bleeding, but there was no recurrent gastric variceal bleeding. Hepatic functional reserve and concomitant hepatocellular carcinoma were the most important prognostic factors in the long term survival by multiple regression analysis. CONCLUSION: We concluded that PD reached both low postoperative mortality and recurrent bleeding rate with good long-term survival. So it could be one of the most effective treatment for the gastric fundal variceal bleeding.
Carcinoma, Hepatocellular ; Classification ; Dissent and Disputes ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Cirrhosis ; Liver Failure ; Mortality ; Retrospective Studies ; Risk Factors ; Splenectomy ; Surgical Procedures, Operative ; Survival Rate ; Varicose Veins

Placental site trophoblastic tumor(PSTT) is a very rare form of gestational trophoblastic disease; weencountered two cases. MR imaging of the first patient revealed a solid uterine mass, slightly hyperintense tonormal myometrium on T1-weighted images and hyperintense on T2-weighted images. After intravenous gadoliniuminfusion, the mass was more enhanced than normal myometrium, and PSTT was confirmed pathologically after totalhysterectomy. In the second patient, PSTT was proven pathologically after laparoscopic left adnexectomy and wedgeresection of the right ovary. Postoperative enhanced CT scans revealed a well-enhanced right ovarian mass andextensive metastasis to the liver, pancreas, both adrenals, the stomach, lung and brain, but no mass was detectedin the uterus. Many of these metastatic lesions were infiltrating low density masses associated with highlyenhanced tubular or serpiginous structures, while some were of very high density.
Animals ; Brain ; Female ; Gestational Trophoblastic Disease ; Humans ; Liver ; Lung ; Magnetic Resonance Imaging ; Mice ; Myometrium ; Neoplasm Metastasis ; Ovary ; Pancreas ; Stomach ; Tomography, X-Ray Computed ; Trophoblastic Tumor, Placental Site* ; Trophoblasts ; Uterus