The Gantzer's muscle (GM) is an additional muscle in the forearm as the accessory head of the flexor pollicis longus (FPL) and accessory head of the flexor digitorum profundus (FDP). We reported a rare case of double GM formed by four muscle bellies. From the dorsal part of flexor digitorum superficialis, small four bellies formed two muscles merging to FDP and FPL, as GMs. These accessory heads of FDP and FPL crossed the ulnar artery and the median nerve, respectively. These additional muscles in the forearm flexor compartment are rare and its clinical and embryological significances should be considered.
Forearm ; Head ; Median Nerve ; Muscles* ; Ulnar Artery

Although intraosseous ganglion of the carpal bones is an uncommon lesion, it can be a cause of chronic wrist pain. Especially, pathologic fracture as complication of idiopathic intraosseous ganglion of the lunate is extremely rare. We report a rare case of idiopathic intraosseous ganglion with pathologic fracture of the lunate that was successfully treated by curettage and autogenous cancellous bone graft.
Bone Cysts* ; Carpal Bones ; Curettage ; Fractures, Spontaneous* ; Transplants ; Wrist

PURPOSE: To date, paraquat poisoning has almost universally resulted in unfavorable outcomes, and it has become a big issue in clinical toxicology. Current efforts to overcome its toxicity have focused on drugs with anti-oxidant capacity such as ascorbic acid in order to combat over-production of reactive oxygen species (ROS) by paraquat radicals, which are mainly induced by NADPH-cytochrome P450 reductase. Unfortunately, this strategy of treatment has not yielded satisfactory results. In search of a new approach to cope with PQ toxicity, we developed an in vitro culture model of cells resistant to lethal doses of PQ, and we then investigated resistance mechanisms using DNA microarray technology, a tool for simultaneously measuring a number of gene expression changes. METHODS: This experiment was conducted in vitro using the hepatocelluar carcinoma cell line (HepG2) to assay xenobitotics metabolism. We induced resistant of these cells to up to 100 uM PQ by treating with escalating doses of PQ for about 5 months. Cytotoxicity was studied using the MTT method, and optical density was measured at 540 nm using an ELISA reader. We examined morphological changes in cells after drug treatment using an inverted microscope, and we investigated gene expression profiles in control and resistant cells by use of DNA microarray. RESULTS: Results of MTT assays indicated that resistant cells showed relatively high survivals against a 100 mM dose, but that the control group had zero percents of survival at a 1 mM dose. In the comparing gene expression levels between the control group and the resistant group, 6,717 genes found to be differentially expressed. In the analysis of anti-apoptosis genes in particular, the resistant group showed more expression of genes with anti-apoptotic functions than did the control group. In examining the expression of cytochrome P450 genes related to xenobiotic metabolism and PQ radical induction, expression of the cytochrome P450 1B1 gene was significantly higher in the resistant group than in the control group. CONCLUSION: Although cytochrome P450 is known to be responsible for redox cycling of PQ as an electron transferor, this study suggest that up-regulation of the cytochrome P450 1B1 gene can corelate with PQ resistance. Therefore, induction of cytochrome P450 1B1 can be a new therapeutic approach to reduce PQ toxicity through actual PQ degradation, rather than simply through neutralization of ROS.
Ascorbic Acid ; Cell Line ; Cytochrome P-450 Enzyme System ; DNA ; Electrons ; Enzyme-Linked Immunosorbent Assay ; Gene Expression ; Hep G2 Cells ; NADPH-Ferrihemoprotein Reductase ; Oligonucleotide Array Sequence Analysis ; Oxidation-Reduction ; Paraquat ; Phosphatidylethanolamines ; Reactive Oxygen Species ; Toxicology ; Transcriptome ; Up-Regulation

Background: To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the threedimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computeraided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods: In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results: On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.

BACKGROUND: Pressure alopecia is the loss of hair following a prolonged immobilization, probably due to pressure-induced local ischemia. It is most commonly observed after surgical procedures under general anesthesia. Most of the studies or reports of pressure alopecia deal with postoperative cases. OBJECTIVE: This study was undertaken to investigate and understand the clinical manifestations, course and histopathological characteristics of pressure alopecia in various circumstances. METHOD: 27 patients with pressure alopecia, who had visited the Department of Dermatology at Busan Paik Hospital between 1998 and 2004, were examined clinically and histopathologically. RESULTS: The ratio of males to females was 4: 5, and the mean age of patients was 36+/-22 years. The cause of pressure alopecia were classified into 5 groups: open heart surgery, craniectomy, other surgeries, long-term bed rest, and the miscellaneous causes including wearing of hair prosthesis and group punishment. The most commonly involved site was the occipito-parietal area. Histopathological examination showed upper dermal edema and fibrosis, follicular fibrosis, melanin pigments, hair follicles in telogen and catagen stages, perifollicular lymphocytic infiltration and vascular change. The mean operation time was 8.1+/-7.2 hours in the patients with temporary alopecia and 17.8+/-7.6 hours in those with permanent alopecia. The mean operation time of the patients with temporary alopecia was shorter than those with permanent alopecia (p<0.05). CONCLUSION: This study revealed several causative factors of pressure alopecia including surgery, long-term bed rest, and miscellaneous causes. Therefore, close observation of the pressure site and changing the position of the patient's head at regular intervals are essential during the various surgical and nonsurgical treatments to prevent pressure alopecia.
Alopecia* ; Anesthesia, General ; Bed Rest ; Busan ; Dermatology ; Edema ; Female ; Fibrosis ; Hair ; Hair Follicle ; Head ; Humans ; Immobilization ; Ischemia ; Male ; Melanins ; Prostheses and Implants ; Punishment ; Thoracic Surgery

Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. However, there is not much information in the literature on the management of these late complications. Because they cause disabling symptoms and socioeconomic problems, some patients with malunion or nonunion of pelvic fractures need to undergo surgery. We report our experience with satisfactory results of surgery for pelvic malunion and nonunion in four patients. The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.
Adult ; Female ; Fracture Fixation, Internal/*instrumentation/*methods ; Fractures, Malunited/radiography/*surgery ; Fractures, Ununited/radiography/*surgery ; Humans ; Pelvic Bones/injuries/radiography/*surgery

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.
Adult ; Analgesia/*methods ; Analgesics/*therapeutic use ; Arthroscopy/*adverse effects ; Female ; Humans ; Hypnotics and Sedatives/*therapeutic use ; Male ; Middle Aged ; Pain Management ; Pain Measurement ; Pain, Postoperative/drug therapy/etiology/*prevention & control ; Postoperative Period ; Prospective Studies ; Pyridines/*therapeutic use ; Rotator Cuff/injuries/*surgery ; Sleep/drug effects ; Treatment Outcome ; Visual Analog Scale

A mediastinal mass was incidentally found on chest radiography in a 46-yr-old woman who had had myasthenia gravis (MG) for 2 months. Computed tomography revealed a 4-cm in size, well-defined, and lobulating mass with nodular calcification that was located in the thymus. Microscopically, the mass consisted of diffuse amorphous eosinophilic materials. These deposits exhibited apple-green birefringence under polarized light microscopy after Congo red staining. Immunohistochemical analysis revealed that they were positive for both kappa and lambda light chains and negative for amyloid A. A diagnosis of localized primary thymic amyloidosis was finally made. After thymectomy, the symptoms of MG were controlled with reduced corticosteroid requirements. Localized thymic amyloidosis associated with MG has not been reported to date.
Amyloidosis/complications/*radiography/*surgery ; Calcinosis/*radiography/*surgery ; Female ; Humans ; Immunoglobulin kappa-Chains/immunology ; Immunoglobulin lambda-Chains/immunology ; Mediastinum/radiography/surgery ; Middle Aged ; Myasthenia Gravis/*complications ; Radiography, Thoracic ; Thymectomy ; Thymus Gland/radiography/surgery ; Tomography, X-Ray Computed

Although vascular injury after humeral fracture is very rare, it is a complication that has serious sequelae. It has been associated with proximal humeral fracture or shoulder dislocation in adults and humeral supracondylar fracture in children. However, delayed brachial artery occlusion after humeral shaft fracture has never been reported worldwide. Nevertheless, delayed brachial artery occlusion after humerus shaft fracture has the potential to cause serious complications in the short term as well as long term; therefore, it is essential to provide accurate diagnosis and prompt treatment. We report a case of delayed brachial artery occlusion after humeral shaft open fracture that was successfully treated with early diagnosis as well as effective treatment.
Adult ; Brachial Artery ; Child ; Early Diagnosis ; Fractures, Open ; Humans ; Humeral Fractures ; Humerus ; Shoulder Dislocation ; Shoulder Fractures ; Vascular System Injuries

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide