The fat adherence syndrome(FAS) is a severe form of the restrictive strabismus resulting from the adherence of orbital tissues to the globe of extraocular muscles and their attachments, for which no successful treatment currently exists. we developed anexperimental model for the FAS in the rabbit eyes and then evaluated the effects of polyurethane film with sustained release dexamethasone on the prevention of experimental FAS. Thirty eyes of fifteen white rabbits had a fat autograft placed between the inferior rectus and the periosteum of the inferior orbital rim and then, the inferior rectus, the fat and the periosteum were sutured to create an experimental FAS. In Group I the experimental FAS was only induced as a control group. The polyurethane film with no released substance and the polyurethane film with sustained release of dexamethasone were inserted between the inferior rectus and the fat in Group II and Group III, respectively. The force required to move the eyeball superiorly 4mm, 6mm, and 8mm was measured preoperatively and 4 weeks ostoperatively. At postoperative 4 weeks the surgical dissection to evaluate the degree of the adhesion and the histologic examination were performed. A significant increase in forced duction(postop-preop) was found at all levels of ocular rotation in Group I and it means that the induction of experimental FAS was successful. Histology revealed a moderate inflammatory response with partial loss of normal adipose tissue replaced by fibrovascular tissue. Group III had significantly less restriction than Group I and Group II. Group II had less restriction than Group I, but statistically not significant. In conclusion, the use of the polyurethane film with sustained release of dexamethasone may have a role in the prevention of experimental FAS.
Adipose Tissue ; Autografts ; Dexamethasone ; Muscles ; Orbit ; Periosteum ; Polyurethanes* ; Rabbits* ; Strabismus

Anterior segment ischemia is a rare, but serious complication of strabismus surgery, Iris microvascular circulation in eyes with blue irides has been investigated by fluorescein iris angiorgaphy, which failed to demonstrate the iris vascular pattern in eyes with heavily pigmented irides like Oriental brown iris. Anterior segment circulation in eyes of Korean after strabismus surgery was investigated by iris angiography using indocyanine green(ICG), which highly penetrates through the pigmented tissue or hemorrhage ICG iris angiography using confocal scanning laser ophthalmolscope was performed before and after strabismus surgery in 20 eyes of 20 Koreans. Tenotomies of medial and lateral recti produced no appreciable circulatory disturbance in the iris in any patients, but there was mild delayed filling in 2 eyes of 6 eyes undergoing tenotomy of one or both vertical recti. When tenotomies of a horizontal and a vertical rectus were combined, the filling defect occurred in the region of radial vessels was observed in eyes with tenotomies of medial rectus and lateral halves of superior and inferior recti. Our study suggests that ICG iris angiography is a useful means for the evaluation of anterior segment circulation I darkly pigmented iris like Oriental brown iris. And there was the remarkable change in iris microvascular circulation only after tenotomy of multiple muscles including vertical rectus muscles.
Angiography* ; Fluorescein ; Hemorrhage ; Humans ; Iris* ; Ischemia ; Muscles ; Strabismus* ; Tenotomy

A buttonhole deformity of the finger is characterized by flexion of the pmximal interphalangeal joint and hyperextension of the terminal interphalangeal joint. When the central slip of the extensor tendon and the triangular ligament are ruptured,(or severed) on the base of the middle phalanx, buttonhole deformity will result.This article is based on clinical and follow up studies of 5 patients with buttonholedeformities. Five cases were treated by the modified Littler method and were followed from 4 months to 24 months postoperatively and good results were obtained in all cases.
Congenital Abnormalities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Methods ; Tendons

Synovial chondromatosis is an uncommon benign lesion characterized by metaplastic cartilage formation within the synovial connective tissue which disintegrates into the joint and continues to grow. Of the eight cases of synovial chondromatosis seen by the authors, three cases involved the knee, two of these were bilateral, three cases involved the elbow, one the hip joint and one the proximal phalanx of the right middle finger. The diagnosis of synovial chondroamtosis was made by histopathological findings of the excised mass. Most synovial chondromatosis cases obtained favorable results by removing masses from the joint and at the same time performing a partial synovectomy, except one case in which degenerative arth ritis had developed proeoperatively.
Cartilage ; Chondromatosis, Synovial ; Connective Tissue ; Diagnosis ; Elbow ; Fingers ; Hip Joint ; Joints ; Knee

Purpose: We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. Materials and Methods: A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. Results: Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. Conclusion Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.

A 42-year-old woman preseated with intermittent rectal bleeding of a week's duration. A large polypoid mass with pigmented, ulcerated, nodular surface was seen in the rectum at 3cm from the anal verge during flexible sigmoidoscopy. A histologic diagnosis of metastatic melanoma wae made on light microscopic examination of biopsies obtained at sigmoidoscopy. The presence of metastatic melanoma at sites other than the rectum was found at the skin, pleura and lung. We report a case of metastatic malignant melanoma of the rectum with the review of the literature.
Adult ; Biopsy ; Diagnosis ; Female ; Hemorrhage ; Humans ; Lung ; Melanoma* ; Pleura ; Rectum* ; Sigmoidoscopy ; Skin ; Ulcer

We report a case of Aspergillus osteomyelitis of the spine in a 52-year-old female with back pain. Anteroposterior and lateral roentgenograms showed narrowing of the intervertebral disc space of T12-L1 with irregular vertebral endplates. MRI showed spondylodiscitis at T12-L1. Although tuberculous spondylitis is far more prevalent that fungal spondylitis, it is difficult to differentiate one from the other radiographically.
Aspergillosis ; Aspergillus* ; Discitis ; Female ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis* ; Spine* ; Spondylitis

Primary CNS lymphoma (PCNSL) which is localized in the cauda equina of the spinal cord is very rare. A 75-year-old man had pain in both legs and gait disturbance for the last 45 days. Painful paresthesia and weakness in both legs worsened during a one month period and he was unable to stand up by himself. In a physical examination, lym-phadenopathy nor organomegaly was found. A neurological examination revealed a dominantly proximal muscle weak-ness of the lower extremities. All modalities of sensation were decreased in both legs and a Romberg test was found positive. A CSF cytology demonstrated a large B-cell lymphoma. Following an extensive evaluation of the patient, the lymphoma was found to be limited in the cauda equina. The patient was treated with systemic dexamethasone. After the treatment, his symptoms were improved and a follow up lumbar spine MRI showed shrunken cauda equina lesions.
Aged ; Cauda Equina* ; Dexamethasone ; Follow-Up Studies ; Gait ; Humans ; Leg ; Lower Extremity ; Lymphoma* ; Lymphoma, B-Cell ; Magnetic Resonance Imaging ; Neurologic Examination ; Paresthesia ; Physical Examination ; Polyradiculopathy* ; Sensation ; Spinal Cord ; Spine

PURPOSE: To determine the frequency of complications and diagnostic accuracy of CT-guided percutaneous automated gun biopsy, and to compare the results with those reported for fine needle aspiration. MATERIALS AND METHODS: Using automated biopsy devices, 118 CT-guided percutaneous biopsies of pulmonary lesions were performed. An 18-gauge needle was used. Final diagnosis was made with operation or other methods. We retrospectively analyzed the frequency of complications and diagnostic yields of 118 biopsies. RESULT: Four of 118(3.3%) patients developed pneumothorax and two of these required chest tube insertion. Other complications were resolved spontaneously. 106 biopsies (89.8%) yielded sufficient tissue for pathologic evaluation. For cases of malignant and of benign disease, sensitivity was 91.8% and 87.7% respectively ; the corresponding figures for diagnostic accuracy were 88.5% and 78.9%. CONCLUSION: CT-guided automated gun biopsy of the pulmonary lesions is safe, witha pneumothorax rate comparable to that of fine needle aspiration. In the absence of a trained cytologist at the time of biopsy, the diagnostic accuracy of automated gun biopsy of pulmonary lesions compared favorably with the reported accuracy of fine needle aspiration.
Biopsy* ; Biopsy, Fine-Needle ; Chest Tubes ; Diagnosis ; Needles ; Pneumothorax ; Retrospective Studies

BACKGROUND/AIMS: Therapies involving bone-marrow-derived mesenchymal stem cells (BM-MSCs) have considerable potential in the management of hepatic disease. BM-MSCs have been investigated in regenerative medicine due to their ability to secrete various growth factors and cytokines that regress hepatic fibrosis and enhance hepatocyte functionality. The aim of this study was to determine the antifibrosis effect of BM-MSCs on activated hepatic stellate cells (HSCs) and the mechanism underlying how BM-MSCs modulate the function of activated HSCs. METHODS: We used HSCs in both direct and indirect co-culture systems with BM-MSCs to evaluate the antifibrosis effect of BM-MSCs. The cell viability and apoptosis were evaluated by a direct co-culture system of activated HSCs with BM-MSCs. The activations of both HSCs alone and HSCs with BM-MSCs in the direct co-culture system were observed by immunocytochemistry for alpha-smooth muscle actin (alpha-SMA). The levels of growth factors and cytokines were evaluated by an indirect co-culture system of activated HSCs with BM-MSCs. RESULTS: The BM-MSCs in the direct co-culture system significantly decreased the production of alpha-SMA and the viability of activated HSCs, whereas they induced the apoptosis of activated HSCs. The BM-MSCs in the indirect co-culture system decreased the production of transforming growth factor-beta1 and interleukin (IL)-6, whereas they increased the production of hepatocyte growth factor and IL-10. These results confirmed that the juxtacrine and paracrine effects of BM-MSCs can inhibit the proliferative, fibrogenic function of activated HSCs and have the potential to reverse the fibrotic process by inhibiting the production of alpha-SMA and inducing the apoptosis of HSCs. CONCLUSIONS: These results have demonstrated that BM-MSCs may exert an antifibrosis effect by modulating the function of activated HSCs.
Apoptosis ; Bone Marrow Cells/*cytology ; Cell Differentiation ; Coculture Techniques ; Hepatic Stellate Cells/*cytology/metabolism ; Hepatocyte Growth Factor/metabolism ; Humans ; Immunophenotyping ; Interleukin-10/metabolism ; Interleukin-6/metabolism ; Liver Cirrhosis ; Mesenchymal Stromal Cells/*cytology/metabolism ; Transforming Growth Factor beta1/metabolism