There are many difficult problems and various methods in the treatment of difficult fractures of the femur. We reviewed the records of twelve patients who had been managed with circular external fixation using the llizarov apparatus for difficult fractures of the femur at Keimyung University. Dongsan rnedical center from October 1993 to April l996. There were ten males and two females with an average age of 42 years (range, 16-74 years). Si.x of twelve patients were severely comminuted supracondylar and intercondylar fractures of the femur associated with severe soft tissue injury (including four open fractures). These patients were treated initially by closed reduction with Ilizarov external fixator and followed by compression-distraction techniques. Four of the remaining six ptients developed infected non-unions after internal fixation of the femur without shortening or bone defect. These infected non-unions were treated by curettage, irrigation and Ilizarov application. After the control of infection, compression - distraction techniques were applied. One of the remaining two patients had severe open comminuted fracture of the supra-intercondyle region of femur associated with diaphyseal segmental bone defect (5cm in length). This patient was treated with closed reduction and internal bone transportation usipg llizarov external fixator. One patient with varus deformity (20 degree) was treated by correction of the deformity and simple compression technique. In three patients, additional autogenous cancellous iliac bone graft was done. The union of the fracture site was obtained in ten patients and the duration of llizarov external fixation was an average of 10 months (range 6-14 months). We experienced several complications; there were twelve patients of limitation of motion of knee, ten patients of pin tract infection, one patient of fracture site non-union, one patient of re-fracture and one patient of femoral artery injury. We concluded that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fractures of the femur in spite of its complexity and high incidence of complications.
Congenital Abnormalities ; Curettage ; External Fixators* ; Female ; Femoral Artery ; Femur* ; Fractures, Comminuted ; Humans ; Incidence ; Knee ; Male ; Soft Tissue Injuries ; Transplants ; Transportation

Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

PURPOSE: Classically air in the portal vein has been detected on plain radiography, but computed tomography and ultrasonography have been shown to be more sensitive. We report a case of air in the PV in a 10-day-old infant with pneumatosis intestinalis with its ultrasonographic and Doppler findings. MATERIAL AND METHODS: The patient was a 10-day-old infant born by cesarean section at 41 weeks. Simple abdomen film revealed branching pattern of radiolucent air shadows within the contour of liver, gas distention of bowel loops and thickenod bowel walls with lincar intraluminal air shadows in abdomcn, suggesting neerotizing enterocolitis. So we performed Doppler ultrasonography. RESULTS: Ultrasonography showed branching pattern of hyperechogenic dots along the lumen of left portal vein. The color Doppler study revcaled an aliasing duo to increased velocity and whirling pattern of blood flow, and the Duplex Doppler spectral display showed sharp, vertical bidirectional spikes by air in portal vein. CONCLUSION: Air in the portal voin can be easily diagnosed by the followign signs:hyperechogenic dots in the portal vein on ultrasonography and vertical, sharp bidirectional spikes superimposod on the usual Doppler tracing of the portal vein on Duplex ultrasonography.
Abdomen ; Cesarean Section ; Enterocolitis ; Female ; Humans ; Infant ; Liver ; Portal Vein* ; Pregnancy ; Radiography ; Ultrasonography ; Ultrasonography, Doppler

We report a caae of hepatic and intestinal infestation with paragonimus wewstermani complicating abscess formation. The pathway by which the paragonimus westermani reaehea liver and intestine is not well understood. However, there was possiblity that it may become lodged in other organs that the lung because of polonged larval migrations through the diaphragm or into various sites in the abdomen. The patient, 52-year-old female gave a history of having reyeatedly consumed raw crabs. An x-ray film of the chest showed clear lunga Skin test for paragonimus-westermani was positive. Abdominal ultrasonogram showed enlargement of the liver with multiple hypoechoic lesiona ERCP revealed multiple ie lesions in the right lobe of the liver. Abdaminal CT showed multifocal abscess cavities with slight rim enhancements. Above meetioned diagnostic procedures suggested liver abscess or hepatoma. Then, an exploratory laparotomy was done for a definite diagnosis, Frozen biopsy, from liver and surgically exe mass from ileocecal region revealed extrpulmonary paragnomiasis involving liver and cecum. Thus, the patient was treated with prasiquantel. Three months later, abdominal ultrasonogram demonstrated slight enlargement of the liver but no evidence of abnormal mass like lesions.
Abdomen ; Abscess ; Biopsy ; Carcinoma, Hepatocellular ; Cecum* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diaphragm ; Female ; Humans ; Intestines ; Laparotomy ; Liver Abscess ; Liver* ; Lung ; Middle Aged ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Praziquantel ; Skin Tests ; Thorax ; Ultrasonography ; X-Ray Film

To evaluate the normal range of articular disk postion, MRIs of 25 temporomandibular joints(TMJs) in 19 asymptomatic volunteers were analysed. On the closed mouth sagittal T1 weighted MRI the junction of the posterior band and bilaminar zone was within 10°anterior from the vertical line through the apex of condylar head in 19 (76%) lad within 20°in 23 (92%) TMJs. The intermediate zone of the articular disk was located between the posterior surface of articular eminence and the anterior surface of condylar head in 22 (88%) TMJs. We suggest that on the closed mouth sagittal MRI the junction of the posterior band and the bilaminar zone could be within 10°anterior from the vertical line through the apex of condylar head in asymptomatic Korean persons. If the junction is located more than 20°anterior from the vertical line or the intermediate zone is anterior to the anterior surface of condylar head it is suggested that the disk is anteriorly displaced. Further studies are needed to evaluate the clinical significance of mild anterior displacement of the articular disk(11°-20°) in asymptomatic persons.
Head ; Humans ; Magnetic Resonance Imaging* ; Mouth ; Reference Values ; Temporomandibular Joint* ; Volunteers

Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

Brunner's gland adenoma(or Brunneroma) is clinically relevant tumor-like lesion of the duodenum which is composed of submucosal Brunner's gland tissue. Since the first case by autopsy was described by Cruveihier in l935, there have been less than 190 reports in the world literature, Brunner's gland adenoma is an extremely rare entity that accounts for only 10.6% of benign duodenal tumors, which are themselves relatively rare representing 0.008% of all surgical and autopsy specimens. The clinical manifestation of this tumor are non-specific gastrointestinal complaints, such as bloating or epigastric pain, and tumor often gives rise to melena or obstruction, It is postulated that this tumor are hamartomas rather than true neoplasm. However, they undergo rarely malignant transformation. We report on a case of a large pedunculated Brunner's gland adenoma, which was successfully polypectomized.
Adenoma* ; Autopsy ; Duodenum ; Hamartoma ; Melena

This paper present a rare case of a Type III Monteggia equivalent fracture with an ipsilateral distal radial epiphyseal (Salter-Harris type II) and an ulnar metaphyseal fracture in a child. An 8-year-old boy sustained a closed bipolar fracture of his forearm after a fall from a height. The closed reduction was unsuccessful. Therefore, an open reduction and plate fixation was performed for a diaphyseal fracture of the ulna, and the unstable radial fractures and the distal ulnar metaphyseal fracture were treated with a closed reduction and internal fixation using Kirschner wires (K-wires). Two years after surgery, the joint motion including the forearm, wrist and elbow were completely normal. Radiologically, the bone was well united without any residual deformity.
Bone Wires ; Child* ; Congenital Abnormalities ; Elbow ; Forearm ; Humans ; Joints ; Male ; Ulna ; Wrist

The authers performed long coloaofiherscopy with barium enema study on 134 cases, of coloreatal diseasea, who had been admitted to the department of Internal Medicine, Kwangiu Christian Hospital from July 1984 to Aupist 1986, The results were following: 1) Among 134 cases of colonoacopy, abnormal findings were 70 cases (52.2%) and normal findings 64 cases (47.8%). 2) among 70 cases of colonoscopic abnormal findings, nonspecific inflammatory colitis were 27 cases, colon tuberculosis 15 cases, colon and rectal cancer 14 cases, colon polyps 8 cases, ulcerative colitis 3 cases, internal hemorrhoid 2 cases, sigmoid diverticular 1 case. 3) The cases in which the findings of barium contrast enema were compatible with those of colonoscopy were 84 cases (62.7%), not compatible 50 cases(37.3%). There were not compatible with findings in 4 cases of colon cancer (10 cases), 7 cases of colon tuberculosis (15 cases), 4 cases of colon polyps (8 cases), 1 case of ulcerative colitis (3 cases). 4) The insertion ratio to ileocecal valve was 79.1%. The rate of correct approach by a colonoscopy to the lesion site shown at barium contrast enema was 94.1%
Barium ; Colitis ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopes* ; Colonoscopy ; Enema ; Hemorrhoids ; Ileocecal Valve ; Internal Medicine ; Polyps ; Rectal Neoplasms ; Tuberculosis

PURPOSE: To understand the normal endosonographic anatomy of the perianal spaces, and to evaluate the diagnostic efficacy and limitation of endorectal sonography(EUS), correlative study with MRI, cadaveric sectional image and cadaveric MRI were performed. MATERIALS AND METHODS: EUS images of the normal 6 perianal spaces (pelvirectal, ischiorectal, intersphincteric, subcutaneous, central, submucous space) which were bounded by internal and external anal sphincters, rectal wall and levator ani muscle were correlated with MRI in 10 normal persons, cadaveric sectional images and cadaveric MRI in 2 cadavers. RESULTS: Pelvirectal space located superior to levator ani muscle could be demonstrable only on anterior wall scan but could not be visualized on lateral or posterior wall scan on EUS. Five perianal spaces located inferior to levator ani muscle were well seen on anterior, lateral, and posterior wall EUS. MRI was superior to EUS in the evaluation of pelvirectal and ischiorectal spaces but equal or inferior to EUS in the evaluation of intersphincteric, subcutaneous, central and submucous spaces. CONCLUSION: EUS was valuable in the evaluation of perianal spaces inferior to levator ani muscle but was limited in the evaluation of perianal spaces superior to levator ani muscle.
Anal Canal ; Cadaver* ; Humans ; Magnetic Resonance Imaging*