Treatment of diseases of the musculoskeletal system can be classified into conservative and surgical management. Injection therapy is one of the conservative methods, which is expected to improve symptoms or disease process by delivering effective medications directly to the involved site. If applied properly, it can be the treatment of choice considering the low cost. However, the natural course of the diseases varies widely, even in the same disease process. Therefore, some cases may be treated with simple rest, oral medication or other conservative measures, while others need sometimes surgery as the treatment of choice, especially of advanced diseases. So, we should bear in mind that injection therapy is just one of many treatment options, which should be employed with strict indications. Corticosteroids are the most frequently used agent for injection therapy. Many corticosteroid preparations are available for joint and soft tissue injection. Recently, the results of clinical applications with intraarticular preparations of hyaluronic acid have suggested some efficacy for degenerative arthritis. To achieve better results of injection therapy, the followings are the prereguisites: Accurate diagnosis Precise knowledge about the disease, indications, preparations of agent, complications and anatomy of the joints skillful technique
Adrenal Cortex Hormones ; Diagnosis ; Hyaluronic Acid ; Joints* ; Musculoskeletal System ; Osteoarthritis

The cubitus varus is one of the most common complications of supracondylar fracture of humerus. The authors treated surgically 45 cases of cubitus varus in the Seoul National University Hospital, from 1977 to 1981, and the results were as follows: 1. The mild ulnar n. palsy signs were found in 11 cases(24.5%). 2. The supracondylar, closed wedge osteotomy was done through lateral approach and fixed by cross pinning with 2 K-wires. 3. The postoperative immobilization must be more complete, and the average duration of immobilization was 7 weeks. The osteotomy site united in the all cases, and no limitation of range of motion developed. 4. The incidence of postop. ulnar nerve palsy was the same in the osteotomy only group as in the osteotomy and ulnar n. transposition group. The osteotomy and ulnar n transpositin group recovered naturally, but 2 cases of the osteotomy only group did not recover so ulnar n. transposition was performed later. 5. There was no recurrence of deformity after the average follow-up of 2.2 years, so it was recommended that the correction of deformity should be done in the early childhood.
Congenital Abnormalities ; Follow-Up Studies ; Humerus ; Immobilization ; Incidence ; Osteotomy ; Paralysis ; Range of Motion, Articular ; Recurrence ; Seoul ; Ulnar Neuropathies

Atypical fibroxnathoma (AFX) is a pleomorphic spindle cell neoplasm of the dermis, and is a clinically-benign reactive lesion, despite apparently malignant histologic features. We describe a case of 16-year-old female with recurrent AFX which developed on the occipital scalp. The lesion was totally excised by Mohs micrographic surgery and no recurrence was observed during one year follow up period. It is uncommon for AFX, such as the present case, to develop on a non-sun-exposed area and in adolescence.
Adolescent ; Dermis ; Female ; Follow-Up Studies ; Humans ; Mohs Surgery* ; Recurrence ; Scalp

PURPOSE: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. METHODS: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. RESULTS: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Concordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Among the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 cases of 4 points (8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 points (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histologic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. CONCLUSION: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defiitive therapy. Confirmatory biopsy might be applied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.
Ambulatory Care Facilities ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast* ; Chungcheongbuk-do ; Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Physical Examination ; Prospective Studies* ; Sensitivity and Specificity ; Ultrasonography

Thirty healthy patients were studied to evaluate the effect of muscle relaxants on intra-ocular pressure (IOP) during anesthesia. The patients were divided intro three groups-succinrlcholine group(Img/k7,n=10) , pancu-ronium group(0.08mg/kg,n=10), and vecuronium group(0, Img/kg,n=10) according to the muscle relaxants used. All patients were premedicated with robinul 0.2mg and lorazepam 4mg one hour before surgery. Tracheal intubation was fellowed by thiopental sodium 5mg/ kg and muscle relaxant. Anesthesia was maintained with O2-N2O-enflurane and respiration and was controlled by anesthetic ventilator (Dameca). The lOP was measured hy Schotz tonometer, before induction of anesthesia, at 75~100% depression of twitch height on train of-four after injection of muscle relaxant, and at 1,3, 5, 10, minutes after intubation respectively. Heart rate, mean arterial pressure, and end-tidal CO2 tensions were also measured simultaneously. The results were as follows ; 1) At 75~100% depression of twitch height, IOP wart elevated significantly in succinylc-holine group but reduced significantly in both pancuronium and vecuronium groups as Compared With pre induction value. 2) IOP was elevated in all groups after 1 minute of intubation, there were no statistical significance in pancuronium or vecuronium group as compared with pre induction value. After 3 minutes of intubation, IOP was reduced in all groups in proportion to the depth of anesthesia. 3) Cardiovascular changes in vecuronium group were less than those in succinrlcholine or pancuronium group. In conclusion vecuronium, with less cardiovascular changes, may be indicated for anest-hesia of open eye injury compare other muscle relaxants.
Anesthesia ; Arterial Pressure ; Depression ; Eye Injuries ; Heart Rate ; Humans ; Intraocular Pressure* ; Intubation ; Lorazepam ; Pancuronium ; Respiration ; Thiopental ; Vecuronium Bromide* ; Ventilators, Mechanical ; Warts

No abstract available.
Animals ; Neurons* ; Rats*

Congenital cystic adenomatoid malformation(CCAM) is one of the most common congenital lung lesions. Clinical manifestations that show are neonatal respiratory distress, recurrent respiratory infection, pneumothorax, and hemothorax. But, there are patients who are asymptomatic until mid-childhood. The treatment of asymptomatic CCAM is controversial. There is a possibility to resolve it spontaneously, but late complications such as recurrent pulmonary infection, pneumothorax, hemothorax, and cancer, which includes bronchoalveolar carcinoma and rhabdomyocarcinoma, pleuropulmonary blastoma still remain. Some investigators advocate routine surgery for all cases of CCAM that are apparent at birth. A previously healthy 16-months-old girl who had suffered from a cough for 2 weeks was transferred to Asan Medical Center with CCAM. Due to a chest CT and fever, we first thought that she had CCAM with infection. After we treated her with antibiotics for one week, we performed surgery to confirm the diagnosis and to prevent further complication. But by surgical wedge resection, a pleuropulmonary blastoma was found. There were no evidence of metastasis and adjacent involvement. She started her chemotherapy with vincristine, actinomycin D and cyclophosphamide, and is now continuing maintenance chemotherapy with etoposide, vincristine, and Ifosfamide. We report pleuropulmonary blastoma that presented as CCAM. So we recommend surgical resection in asymptomatic CCAM to confirm the diagnosis and to prevent its malignant transformation, even not accompanied by symptoms.
Anti-Bacterial Agents ; Child ; Chungcheongnam-do ; Cough ; Cyclophosphamide ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Dactinomycin ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Fever ; Hemothorax ; Humans ; Ifosfamide ; Lung ; Maintenance Chemotherapy ; Neoplasm Metastasis ; Parturition ; Pneumothorax ; Research Personnel ; Tomography, X-Ray Computed ; Vincristine

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.
Brain ; Edible Grain ; Cerebellar Nuclei ; Corpus Callosum ; Education ; Fruit ; Fumigation ; Globus Pallidus ; Humans ; Insects ; Magnetic Resonance Imaging ; Occupations ; Periaqueductal Gray ; Poisoning ; Red Nucleus ; Seizures* ; Soil ; Substantia Nigra ; Tectum Mesencephali

PURPOSE: This study evaluated the usefulness of a new scoring system in diagnosing acute appendicitis which expresses the patient's symptoms, physical examination, and laboratory findings more clearly and objectively. METHODS: A prospective study was conducted with 314 patients who were hospitalized with suspicion of acute appendicitis. After analyzing the symptoms, physical examination, and laboratory findings, 10 meaningful variables were selected, each of which were scored separately. The diagnostic value of the new scoring system was evaluated, and analyzed in comparison to the preexisting Alvarado score. RESULTS: Ten variables including vomiting, migration pain, fever, Dunphy's sign, Rovsing's sign, tenderness, rebound tenderness, increased white blood cell counts, increased neutrophil proportion, and increased CRP levels were associated with acute appendicitis. The new scoring system is developed by applying 1 point for each variable, with a total score of 10 points. In the new scoring system, a score above 5 points had sensitivity of 0.75, specificity of 0.73, positive predictive value of 0.92, and diagnostic accuracy of 0.71. The area under the receiver operating characteristic curve was 0.80, which is larger than 0.72 of the preexisting Alvarado score, and thus has a higher diagnostic accuracy. As acute appendicitis progresses, the average score tends to become significantly higher (P=0.001). CONCLUSION: The new scoring system, which objectively reflects the clinical variables of the patient's symptoms, physical examination and laboratory findings, will be useful in accurately diagnosing acute appendicitis and in quickly deciding a therapeutic policy in patients with right lower abdominal pain.
Abdominal Pain ; Appendicitis ; Fever ; Humans ; Leukocyte Count ; Neutrophils ; Physical Examination ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Vomiting

Hepatitis viruses (hepatitis B virus (HBV) and hepatitis C virus) have been associated with development of inflammatory arthritis. Approximately 400 million people worldwide have chronic HBV infection. HBV infection is the one of the most common causes of liver disease, and the prevalence of HBV infection in Korea is almost 6%. Arthritis in patients with HBV can be encountered in two settings: as a rheumatoid arthritis (RA)-like, acute, self-limited polyarthritis during the pre-symptomatic phase of acute hepatitis B, or, more rarely, as arthritis occurring in the context of HBV-associated polyarteritis nodosa (PAN). In both cases, the pathogenesis of arthritis is attributed to the deposition of immune complexes containing viral antigens (HBsAg or HBeAg) and their respective antibodies (anti-HBs and anti-HBe) in synovial tissues. Here we report on a case of polyarthritis associated with reactivation of chronic hepatitis B virus infection with a review of the literature.
Antibodies ; Antigen-Antibody Complex ; Antigens, Viral ; Arthritis* ; Arthritis, Rheumatoid ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis C ; Hepatitis Viruses ; Hepatitis, Chronic* ; Herpesvirus 1, Cercopithecine ; Humans ; Korea ; Liver Diseases ; Polyarteritis Nodosa ; Prevalence ; Viruses