One of the serious and challenging problems confronting orthopaedic surgeons is an open un-united fracture of tibia. Especially, there are some difficulties in getting bone union on the condition of combining soft tissue defect with infection. In the management of infected un-united fracture of tibia with significant soft tissue loss we attempted a two-stage reconstruction : the first stage consisted of radical sequestrectomy, soft tissue reconstruction, and external fixation, and the 2nd stage consisted of various types of bone grafting and bone fixation. Fifteen patients with open infected un-united fractures of tibia treated with staged reconstruction from September 1982 to August 1987 at Department of Orthopaedic Surgery, Dae-Jeon's St. Mary's Hospital, Catholic University Medical College, were analyzed in clinical aspects and the results of treatment obtained were as follows : 1. Satisfactory bone union was obtained in an average of 6 months after bone graft with a range of 4 months to 12 months. 2. The duration from the injury to bone union was 13 months on an average with a range of 8 months to 19 months. 3. The soft tissue rer.onstruction at the first stage were performed with local flap in 11 cases and muscular flap in 2 cases and musculocuteneous flap in 2 cases. 4. The time interval between 1st stage and 2nd stage was from 1.5 months to 3 months. 5. At the 2nd stage, bone graft were performed with autogenous cancellous bone graft in 11 cases, vascularized osteocutaneous fibular graft in 2 cases and ipsilateral vascularized fibular transference in 2 cases. In summary, a two-stage reconstruction for open infected un-united fracture of tibia is a advisable procedure that leads to bone union with satisfactory return of function.
Bone Transplantation ; Fractures, Open ; Humans ; Surgeons ; Tibia ; Transplants ; United Nations

Osteotomy around the knee is a widely considered surgical procedure for osteoarthritis with lower extremity malalignment. High tibial osteotomy (HTO) is performed for varus deformity, while distal femur osteotomy (DFO) is performed for valgus deformity. However, if the correction is insufficient, double osteotomy can also be considered. This report included the basic principles and current concepts of patient selection and preoperative planning in osteotomy around the knee.
Congenital Abnormalities ; Femur ; Knee Joint ; Knee* ; Lower Extremity ; Osteoarthritis ; Osteotomy* ; Patient Selection

The calyceal diverticulum is a cystic cavity lined by a transitional epithelium, is encased within the renal substance, and is situated peripheral to a minor calyx, to which it is connected by a narrow channel. Both congenital and acquired factors have been suggested to explain the formation of a calyceal diverticulum. We experienced a case of a huge calyceal diverticulum that was newly developed after a renal injury.
Diverticulum ; Epithelium ; Kidney

Segmental testicular infarction is a rare cause of acute scrotum. Its etiology is not well defined and it can be clinically confused with a testicular tumor. Imaging studies play an important role in the preoperative diagnosis, with a Color doppler ultrasonography as the investigation of choice although magnetic resonance imaging (MRI) can be useful in doubtful cases. We report a case of segmental testicular infarction treated with partial orchiectomy seen in a 58-year-old man with right scrotal pain.
Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Orchiectomy ; Scrotum ; Testis ; Ultrasonography, Doppler, Color

PURPOSE: Testicular volume is one of the important indices that represent the reproductive ability of adult males. In previous studies, however, testicular volume was measured by manual palpation or orchidometer, resulting in inaccuracy or subjectivity. Accordingly, the need for accurate data on the size of the testes is increasing, and we conducted testicular volume measurements by using scrotal ultrasonography. We investigated the relationship between testicular volume and body weight, height, and body mass index (BMI). MATERIALS AND METHODS: The testicular volumes of 1,002 young adult Korean men were measured for length, width, and thickness with ultrasonography, and data on BMI were collected conventionally. The correlation between testicular volume and BMI was analyzed with one-way ANOVA and Student's t-test. RESULTS: The mean age of the young men was 23.02+/-2.53 years. The mean testicular volume was 18.09+/-3.79 cc on the left and 18.26+/-3.21 cc on the right. Testicular volume was directly proportional to body weight, height, and body mass index. CONCLUSIONS: The testicular volume of Korean young adult men was about 18.17 cc. Testicular volume has a weak direct correlation with body weight, height, and body mass index.
Adult ; Body Mass Index ; Body Weight ; Humans ; Male ; Palpation ; Testis ; Young Adult

Purpose: To evaluate the clinical and radiological results of hip arthroplasty using a cementless modular femoral stem in patients older than 70 years with a femoral neck fracture. Materials and Methods: From January 2002 to May 2005, 67 hip arthroplasty procedures (66 patients) using a cementless modular femoral stem for displaced femoral neck fractures in patients older than 70 years of age were evaluated. All the patients were followed up for more than 2 years. The mean age at surgery was 77 (70~92) years. There were 22 men and 44 women. The mean follow up period was 31 months (24~41). The clinical evaluation was performed by examining the perioperative Activities of Daily Living (ADL) and postoperative complications. The radiological evaluation for femoral stem loosening and osteolysis was performed using the serial postoperative radiographs. The radiological evaluation for leg length discrepancies was performed using the immediate postoperative radiograph. Results: In preoperative ADL, 31 cases (46%) were in grade 1, 21 (31.5%) in grade 2, 14 (21%) in grade 3, 1 (1.5%) in grade 4 and none in grade 5. A review of the postoperative ADL revealed 25 cases (37.5%) in grade 1, 18 (27%) in grade 2, 21 (31%) in grade 3, 3(4.5%) in grade 4 and none in grade 5. Postoperative restoration of the ADL was observed in 48 cases (71.5%). There were no significant complications. Radiographically, all cases showed stable bony fixation of the femoral stem with the exception of 1 case, who showed subsidence and a pedestal reaction. Postoperative leg length discrepancy was observed in 5 cases (7.5%) but was <1 cm in all cases. Conclusion: In elderly patients older than 70 years of age with a displaced femoral neck fracture, cementless hip arthroplasty using a modular femoral stem provides good initial stability and subsequent secure bony fixation with minimal complications.
Activities of Daily Living ; Aged ; Arthroplasty ; Female ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Leg ; Male ; Osteolysis ; Postoperative Complications

Purpose: Triple-negative breast cancer (TNBC) represents a major clinical challenge due to its aggressive and metastatic behavior and the lack of available targeted therapies. Therefore, therapeutic strategies are needed to improve TNBC patient management. Recently, atezolizumab and nab-paclitaxel chemotherapy has been approved by the Food and Drug Administration for the first-line treatment of patients with locally advanced and metastatic TNBC. The programmed death-ligand 1 (PD-L1) immunohistochemical SP142 assay was also approved as a companion diagnostic device for selecting TNBC patients for atezolizumab treatment. This study aimed to evaluate and compare the analytical performance of the PD-L1 22C3/SP263 assays in comparison with the SP142 assay for ≥ 1% immune cells (ICs). Methods: Immunohistochemical expression for the PD-L1 22C3/SP263 assays, in comparison with the SP142 assay, was analyzed for the ≥ 1% ICs in 95 TNBCs. Results: At the 1% cut-off value, the proportions of positive cases were 52.6% for the SP142 assay in infiltrating ICs and 50.5% and 52.6% for the 22C3 and SP263 assays in tumor cells, respectively. The PD-L1 SP263 assay had the highest while the PD-L1 22C3 assay had the lowest total positive expression rate at all cut-off values. The concordance rate between the assays was highest at a 1% cut-off value and decreased when the cut-off value increased.The concordance rate between the SP142 and SP263 assays at 1% cut-off was high, while in comparison, the concordance rate between the SP142 and 22C3 assays at 1% cut-off was relatively lower. Conclusion This study demonstrates that although the 22C3 assay at a 1% cut-off value compared with the PD-L1 SP142 assay at the clinically relevant cut-off shows comparable but not interchangeable analytical performance, the analytical performance of the SP263 assay at a 1% cut-off value shows interchangeable performance with the PD-L1 SP142 assay at the clinically relevant cut-off.

PURPOSE: To help predict the severity of ocular complications in orbital blunt trauma by analyzing clinical features of ocular complications and orbital wall fracture. METHODS: A retrospective survey consisting of 169 eyes of 168 patients with orbital blunt trauma who visited Kosin University Gospel Hospital was performed. The patients' age, gender, height, weight, cause of accident, and ocular complications were investigated. The patients were imaged using computer tomography and divided into two groups according to whether they had orbital wall fracture: the orbital contusion group and the orbital wall fracture group. Variables of orbital wall fracture, including the location, length, width, and area were measured using computer tomography in the orbital wall fracture group. RESULTS: The incidence of ocular complication was 27 of 67 eyes (40.2%) in the orbital wall fracture group and 75 of 102 eyes (73.5%) in the orbital contusion group; ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group (p < 0.001). Among causes of the accident, 'flying object' showed the highest incidence of ocular complication at 40 of 48 eyes (85.1%). In the orbital wall fracture group, there was no significant difference in orbital fracture location, length, width or area between the ocular complication group and the non-ocular complication group. CONCLUSIONS: Ocular complications were found significantly more often in the orbital contusion group than in the orbital wall fracture group, and 'flying object' showed the highest incidence of ocular complication among causes of the accident.
Contusions ; Humans ; Incidence ; Orbit* ; Orbital Fractures ; Retrospective Studies

PURPOSE: Takayasu's arteritis generally involves the aorta and its main branch. Various ocular manifestations associated with Takayasu's arteritis have been reported, but branch retinal artery occlusion (BRAO) is very rare. We report a case of BRAO associated with Takayasu's arteritis. CASE SUMMARY: 53-year-old female patient visited out emergency room for an inferior visual field defect of the right eye that had presented 2 hours earlier. Visual acuity was 1.0 in both eyes. There were no abnormalities of the anterior segment or pupil reflex. On fundus examination, superior retinal whitening was observed in her right eye. Through ancillary study including optical coherence tomography and fluorescein angiography, she was diagnosed with BRAO and underwent conservative treatments. She had received previous treatment and had been followed-up for Takayasu's arteritis for 20 years. She complained of general weakness, and body temperature was 38.7℃. On blood analysis, erythrocyte sedimentation rate and C-reactive protein were increased compared to previous levels. She was medically treated on the assumption of relapse of Takayasu's arteritis. After 3 months, the retinal whitening in her right eye was resolved, but the visual field defect remained similar to that at the initial visit. CONCLUSIONS: We report this rare case of BRAO associated with Takayasu's arteritis, indicating the need to consider an association between the two diseases.
Aorta ; Blood Sedimentation ; Body Temperature ; C-Reactive Protein ; Emergency Service, Hospital ; Female ; Fluorescein Angiography ; Humans ; Middle Aged ; Pupil ; Recurrence ; Reflex ; Retinal Artery Occlusion* ; Retinaldehyde ; Takayasu Arteritis* ; Tomography, Optical Coherence ; Visual Acuity ; Visual Fields

PURPOSE: The purpose of this study is to report the short-term outcomes of revision total hip arthroplasty (THA) using tantalum augments in patients with severe acetabular bone defects. MATERIALS AND METHODS: We retrospectively analyzed 15 revision THAs performed in 15 patients using tantalum augments between June 2010 and December 2013. Acetabular bone defects were Paprosky type IIIA in 7 hips, type IIIB in 7, and type IV in 1. The causes of revision surgery were aseptic loosening in 12 hips and deep infection in 3. Revisions were first in 1 hip, second in 3, and third in 11. Six patients were male and 9 female with a mean age of 59 years (range, 48-75 years). Mean follow-up was 29 months (range, 24-48 months). RESULTS: Mean Harris hip score was improved from 34 points (range, 12-54 points) preoperatively to 84 points (range, 38-90 points) at final follow-up. On the final follow-up radiographs, there were 12 hips (80.0%) with stable fixation of the acetabular cup, 2 (13.3%) with secondary stability after mild acetabular protrusion, and 1 (6.7%) with radiolucency around the acetabular cup without mechanical symptoms. Complications included one patient with acute hematogenous infection managed by surgical debridement and long-term antibiotic therapy. There were no cases with nerve palsy or dislocation during the follow-up period. CONCLUSION: The present study showed satisfactory clinical and radiographic outcomes of revision THA using tantalum augments due to severe acetabular bone defects of Paprosky type III or IV at a minimum follow-up of 2 years.
Acetabulum* ; Arthroplasty, Replacement, Hip* ; Debridement ; Dislocations ; Female ; Follow-Up Studies* ; Hip ; Humans ; Male ; Paralysis ; Retrospective Studies ; Tantalum*