PURPOSE: We report a distinctive lesion in the articular cartilage of the talar dome in anterior bony impingement syndrome of the joint. MATERIALS AND METHODS: Arthroscopic debridement was done in 68 ankles under the diagnosis of anterior impingement syndrome of the ankle joint between October 1994 and June 1996. There were 6 tram track lesions of talar dome of the 68 ankles. We evaluated arthroscopic findings of tramtrack lesion, injury mechanism, and treatment results according to the criteria of Ogilvie-Harris DJ et al. RESULTS: All six male patients were professional or collegiate soccer players. Average age was 29 years (26 to 34). All 6 cases were dorminant ankles. Trauma history was not definite in all 6 cases. All 6 patients were anterior impingement syndrome of the ankle and treated by arthroscopic removal of osteophytes. The cartilage lesions were full thickness defects, located in the anterior half of the medial aspect of the talar dome and were longitudinal with variable widths resembling a tram track, thus named ""tram track lesion"". Tram track lesion and osteophytes were contacted by ankle dorsiflexion. Overall, good and excellent results were achieved in five patients at a mean follow up of twenty-seven months. Two cases had recurrences of osteophytes. CONCLUSIONS: Tram track lesion of talar dome occurred by repeated scratching of the osteophyte of distal tibia and treated effectively by arthroscopic removal of osteophyte and debridement.
Ankle ; Ankle Joint ; Arthroscopy ; Cartilage ; Cartilage, Articular ; Debridement ; Diagnosis ; Diphenhydramine ; Follow-Up Studies ; Humans ; Joints ; Male ; Osteophyte ; Recurrence ; Soccer ; Tibia

Vascular ingrowth is essential for the survial of the graft tissue. The purposes of this study were to evaluate any changes in signal intensity of cqropreserved meniscal allograft with time in the magnetic resonance images(MRI) and to demonstrate the viability of the grafts. Eight patients underwent meniscal transplantation with cryopreserved allcgrafts using the bone block technique. MRIs of the knee were taken at 3 days, 3 weeks, 6 weeks, 3 month, 6 months. And I year after the implantation. A second-look arthroscopy and a small meniscal biopsy(sized 2mm x 2mm1 at the peripheral and central part of the meniscus were conducted at 3 months and 1 year. Three days after the operation, the signal intensity of the implanted meniscus revealed a homogenrous low signaJ intensity that could not be differentiated from that of' a contralateral normal meniscus. At 3 weeks, a high signal intensity appeared at the periphery of the meniscus. This signal, which did not communicate into the joint space, fuither intensified at 6 weeks. The high signal intensity of the meniscus, though still higher than that of the normal meniscus, decrexsed slightly at 3 months and continued to decrease progressively even a year after the implantation. The second-look arthroscopy revealed that the grafts were viable and that there was no tearing or shrinking of the meniscus. Cellular proliferation was also found at the central edge oi' the meniscus at 3 months. This cellular pattern differentiated from that of a nonmal meniscus in that the d stribution of cells was not in an even, but in a clonal pattem. The cellularity after a year, however, was sirnilar to that of normal meniscus except some area with deficiency of cells. It can be concluded that increased signal intensity of' the implanted meniscus with time indicates hypervascularity caused by vascular ingrowth, similar to the high signal intensity ot>tained from normal meniscus in young children. Increasecl signal intensity in the chronological postoperative MRls demonstrates the viability of the implanted cryopreserved meniscal allograft.
Allografts* ; Arthroscopy ; Cell Proliferation ; Child ; Humans* ; Joints ; Knee ; Magnetic Resonance Imaging* ; Transplants

Early MRI and arthroscopic findings were compared to evaluate the efficacy of the former for patients, who upon physical examination, were diagnosed with possihle acute ACL tears. MRI, taken between 1-21 days after injury, had to reveal complete ACL tears and arthroscopic surgery should have taken place 3-12 weeks after the injury for patients of this prospective study. Fifty such cases were initially catagorized according to five MRI patterns. Types I to V were separated by the following ACL tear characteristics: Enlarged and diffusely increased in signal, horizontally oriented, non-visualized, discontinuous and vertically oriented. The cases were then divided into two groups of arthroscopic findings; Group A included cases of complete ACL tearing and group B included those with intact or minimally torn ACLs. Of MRI types I through V, there were 31, 9, 5, 4, and I cases of each respectively. 37 cases resulted in complete ACL tears (21 type I, 6 type II, 5 type III, 4 type IV and 1 type V) and 13 cases were catagorized into group B, 10 of which had pattern type I and 3 of which had pattern type II. As result, types III, IV and V had a 100% Positive Predictive Value (PPV) whereas types I and II together had a 67% PPV vaiue. Division of the cases into the five pattern types in early MRI proved valuble for possible cases of acute ACL tears. MRI pattern types III, IV and V were correlated with definite complete ACL tears. However, caution must be taken for types I and II, the majority of the cases, for which there exists a significant possibility for misdiagnosis and consequently unnecessary arthroscopic surgery.
Arthroscopy ; Diagnostic Errors ; Humans ; Knee ; Magnetic Resonance Imaging* ; Physical Examination ; Prospective Studies

OBJECTIVE: The changes of magnetic resonance signal intensity after the local steroid injection in to the muscle and tendon in mongrel dogs and the subacromial spaces of patients were studied. MATERIALS AND METHODS: Local injection of the methylprednosolone acetate was performed in muscles and tendons of the limbs of ten mongrel dogs and rotator cuffs of patients. Normal saline was injected in to six muscles and tendons as a control. MR imaging was obtained before and after the local injection of methylprednisolone and the normal saline. RESULTS: After one week and two weeks after the injection, increased signal intensity on T2-weighted fast spin echo MR image was found in four and five of ten muscles and tendons respectively, to which methylpredisolone was injected. None of the muscles or tendons, to which normal saline was injected, showed increased signal intensity on follow-up MR imaging. The cases with increased signal intensity were interpreted as having a inflammation or injury. Moreover, in the clinical study, two of five patients who underwent local steroid injection showed an area of increased signal intensity on T2-weighted fast spin echo MR imaging. CONCLUSION: MR images after local steroid injection should be interpreted carefully with regard to the previous steroid injection.
Adult* ; Animals ; Dogs* ; Extremities* ; Follow-Up Studies ; Humans ; Humans* ; Inflammation ; Magnetic Resonance Imaging ; Methylprednisolone ; Muscles* ; Rotator Cuff* ; Shoulder Pain ; Tendons*

Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.
Adult ; Hernia/*complications/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/surgery ; Male

Gallbladder torsion, also known as volvulus, is a rare condition that can be fatal unless surgery is performed expediently.AWe report a case of gallbladder torsion. A 92-year-old woman presented with acute abdominal pain. Laboratory parameters were all within normal limits, with the exception of leukocytosis. Plain abdominal radiography showed no remarkable findings. Abdominal CT revealed an abnormal gallbladder with wall thickening, suggesting the presence of acute cholecystitis. At operation, the gallbladder was twisted, and the wall of was thickened with acute inflammation. We report the details of this case along with a review of the literature.
Abdominal Pain ; Cholecystitis, Acute ; Female ; Gallbladder ; Humans ; Inflammation ; Intestinal Volvulus ; Leukocytosis ; Radiography, Abdominal

No abstract available.
Adenoma, Oxyphilic*

BACKGROUND: Cystic fibrosis is a chronic progressive autosomal recessive disorder caused by the CFTR gene mutations. It is quite common in Caucasians, but very rare in Asians. Sweat chloride test is known to be a screening test for the cystic fibrosis due to the fact that electrolyte levels in sweat are elevated in patients. In this study, sweat chloride levels in Korean population were measured and analyzed by using standardized pilocarpine iontophoresis sweat chloride test. METHODS: The sweat chloride test was performed in 47 patients referred to Yondong Severance Hospital from August, 2001 to April, 2007 and 41 healthy volunteers. The sweat chloride tests were conducted according to the CLSI C34-A2 guideline using pilocarpine iontophoresis method, and the chloride concentrations in sweat were measured by mercurimetric titration. RESULTS: Four patients showed sweat chloride concentrations higher than 60 mmol/L. Reference interval was calculated as 1.4-44.5 mmol/L by analysis of the results of healthy volunteers (n=41). Four patients who exhibited high sweat chloride levels, had characteristic clinical features of cystic fibrosis and their diagnoses were confirmed either by repeated sweat chloride test or genetic analysis. CONCLUSIONS: Standardized sweat chloride test can be utilized as a useful diagnostic tool for cystic fibrosis in Koreans. In cases of sweat chloride levels higher than 40 mmol/L, the test should be repeated for the possible diagnosis of cystic fibrosis. All the confirmed Korean cases of cystic fibrosis showed sweat chloride level above 60 mmol/L.
Adolescent ; Adult ; Child ; Child, Preschool ; Chlorides/*analysis/*standards ; Cystic Fibrosis/*diagnosis/genetics ; Female ; Humans ; Infant ; Iontophoresis/methods ; Korea ; Male ; Middle Aged ; Pilocarpine/chemistry ; Sequence Analysis, DNA ; Sweat/chemistry/*secretion

Melanoma can occur as a metastasis within subcutaneous tissue, lymph nodes, or viscera without a detectable primary tumor. Among patients with metastatic melanoma of unknown primary lesion, those with endobronchial metastasis are exceedingly rare. Herein we report a case of an endobronchial and pulmonary metastasis in a patient with melanoma originating from an unknown primary site. The patient without a previous history of melanoma presented with blood-tinged sputum. Fiberoptic bronchoscopy revealed a black polypoid tumor obstructing the posterior basal segmental bronchus of the right lower lobe. A final diagnosis of the malignant melanoma was made based on an immunohistochemical study of the bronchoscopic biopsy specimen. Skin, ophthalmic, oral, and nasal examinations failed to identify occult primary lesions. Subsequent evaluation including positron emission tomography/computed tomography scans did not uncover any abnormalities other than the metastatic pulmonary melanoma. We also describe the characteristic bronchoscopic features of melanoma.
Biopsy ; Bronchi ; Bronchoscopy ; Electrons ; Humans ; Lymph Nodes ; Melanoma ; Neoplasm Metastasis ; Skin ; Sputum ; Subcutaneous Tissue ; Viscera

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for schizophrenia to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Schizophrenia patients in clinical settings in Korea. METHODS: A total of 108 schizophrenia and schizophreniform disorder patients were enrolled at 19 centers and treated according to the algorithm. PANSS (Positive and Negative Symptom Scale) and CGI (Clinical Global Impression) were used to evaluate symptom severity. Also UKU (UKU side effect rating scale) and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale), DAI-10 (Drug Attitude Inventory-10), PPS (Patient Preference Scale), SWN (Subjective Well-Being under Neuroleptic treatment) and WHOQOL (World Health Organization Quality of Life) were used to evaluate tolerability and satisfaction of patient respectively. RESULTS: Overall ratings including symptom severity, compliance of medication, side effect of medication, quality of life were favorable. The treatment response (PANSS improvement > or = 20%) rate was 63%, 75% at the first Clinical decision point (CDP) and 4 month respectively. CONCLUSION: Symptom improvement, tolerability and quality of life were all favorable. These results suggest that this algorithm can be useful in clinical practices.
Compliance ; Humans ; Korea ; Psychotic Disorders ; Quality of Life ; Schizophrenia ; World Health Organization