External fixators are popular in treatment of the open fractures of long bones, especially tibia, associated with soft tissue injury, because they prevent further injury to the injured soft tissue and bone. Over the past ten years, bilateral frame external fixtors such as Hoffmann system had been used for lower extremity lesions. But they had many disadvantages like that bilateral frames were less rigid in A-P plane bending moment mechanically, therefore unilateral frame external fixators such as Monofixateur have been introduced recently. The Monofixateur was able to fix the fracture rigidly and compress, distract and neutralize the fracture site and could be used as a static and dynamic stabilizer. We have treated 19 cases using Monofixateur of the Gotzen type for open fractures of lower extremity from October 1984 to Febrary 1987. The summary of the results obtainained from this study are as follows : 1. Monofixateur was easy to use, simple and light. It provided a rigid stability to fracture. 2. It was possible to allow static stabilization on the unstable fracture, whereas dynamic stabilization on the stable fracture. 3. Application was easier than any other type of external fixators from the view point of using a few screws and unilateral frame, therefore it could prevent further soft tissue injury and was easy to secondary operation. 4. It was possible to use for short fracture fragment of the proximal or distal fractures of the long bone. 5. The fracture healing time averaged 32.5 weeks and there were marked differences of the fracture healing time between open type I, II and III fractures. 6. There was little complication such as pin tract infection and ankylosis of the joint.
Ankylosis ; External Fixators ; Fracture Healing ; Fractures, Open ; Joints ; Lower Extremity ; Soft Tissue Injuries ; Tibia

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

The most common cause of orbital in/fection is a sinusitis, and if this orbital complication is not provided with appropriate and intensive treatments, serious status such as visual loss or life-threatening may occur. Osteomyelitis rarely results from sinusitis, and in cases where it happens, the frontal sinus is the most frequently involved site. However, zygomatic osteomyelitis has not been reported so far. We present a case of maxillary sinusitis which was initiated by oroantral fistula, and developed to preseptal and postseptal abscess, penetrating into the orbital septum. The case was complicated by zygomatic osteomyelitis. This case was successfully treated by draining pus by endonasal endoscopic sinus surgery, infraorbital incision, and was followed by antibiotic therapy for about 8 weeks.
Abscess* ; Frontal Sinus ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit ; Oroantral Fistula ; Osteomyelitis* ; Sinusitis ; Suppuration

BACKGROUND AND OBJECTIVES: Recently, canal down mastoidectomy tends to be more frequently selected for complete eradication of the lesion and prevention of recurrence. Therefore, the problems attendant to the open mastoid continue to be of concern. Although various techniques have been used to solve the cavity problems, no single procedure has yet been devised that entirely accomplished this purpose. We evaluated the effects of partial mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips. MATERIALS AND METHODS: Twenty four cases were performed with mastoid obliteration using inferior based musculoperiosteal flap and autogenous conchal cartilage chips obtained from meatoplasty. There were 11 cases for control which were performed with canal down mastoidectomy without obliteration. We compared these two groups in the duration of epithelialization, accumulation of debris, presence or absence of drainage, shape of remodeled canal and caloric response and evaluated survival or atrophy of flap and absorption of cartilage chips. RESULTS: Obliteration group showed more rapid healing and epithelialization and less accumulated epithelial debris. Atrophy of flap or absorption of cartilage was not observed. There was no draining ear but vertigo with nystagmus on caloric stimulation developed in both groups. CONCLUSION: This partial mastoid obliteration technique used easy and quick application instead of complete restoration of canal wall, and it may be also valuable in providing rapid epithelialization and reducing mastoid bowl volume with relatively round canal shape. Furthermore, epitympanic obliteration using cartilage chips may be an effective method to prevent formation of attic retraction pocket.
Absorption ; Atrophy ; Cartilage* ; Drainage ; Ear ; Methods ; Recurrence ; Vertigo

Radiation therapy (RT) has improved patient outcomes, but treatment-related complicationrates remain high. In the conventional 2-dimensional and 3-dimensional conformalRT (3D-CRT) era, there was little room for toxicity reduction because of the need to balancethe estimated toxicity to organs at risk (OARs), derived from dose-volume histogramdata for organs including the lung, heart, spinal cord, and liver, with the planning targetvolume (PTV) dose. Intensity-modulated RT (IMRT) is an advanced form of conformal RTthat utilizes computer-controlled linear accelerators to deliver precise radiation doses tothe PTV. The dosimetric advantages of IMRT enable better sparing of normal tissues andOARs than is possible with 3D-CRT. A major breakthrough in the treatment of esophagealcancer (EC), whether early or locally advanced, is the use of proton beam therapy (PBT).Protons deposit their highest dose of radiation at the tumor, while leaving none behind;the resulting effective dose reduction to healthy tissues and OARs considerably reducesacute and delayed RT-related toxicity. In recent studies, PBT has been found to alleviatesevere lymphopenia resulting from combined chemo-radiation, opening up the possibilityof reducing immune suppression, which might be associated with a poor prognosis incases of locally advanced EC.

Tracheoesophageal fistula is a rare disease of abnormal communication between esopha- gus and respiratory system. The common causes are the acquired origins in adult such as trauma, infection of the adjacent organs, malignant tumor, and foreign body. Among the traumatic origins, chemical drug, the procedure of the dilatation on the stenotic area, blunt trauma(fall, collisions), penetrating trauma(bullet, knife), and pressure injury are much more common than others. Recently, trauma and foreign body in the esophagus and bronchus are becoming the main cause of the tracheoesophageal fistula, however the frequency of the development of tracheoesophageal fistula caused by the infectious diseases is getting decreased. Fibrinogen-thrombin glue stimulates the healing process of the wound and the ulcer. We treated a 52-year-old male patient with nan-inalignant tracheoesophageal fistula, who had symtoms of pharyngolaryngeal and chest discomfort concomitant with a paroxysmal cough on swallowing food which were caused by fish bone. The diagnosis of tracheoesophageal fistula was made by the esophagogram, chest CT, and esop aecopy. By using the therapeutic endoscopy with an injection of the fibrinogen-glue, the tracheoesopeal fistula was obliterated completely with dramatic symptomatic improvement. Here we conqluded that this method would be the one of the best methods for the treatment of tracheoesophageal fistula.
Adhesives* ; Adult ; Bronchi ; Communicable Diseases ; Cough ; Deglutition ; Diagnosis ; Dilatation ; Endoscopy ; Esophagus* ; Fibrinogen* ; Fistula ; Foreign Bodies ; Humans ; Intestines* ; Male ; Middle Aged ; Rare Diseases ; Respiratory System ; Stomach* ; Thorax ; Thrombin* ; Tomography, X-Ray Computed ; Tracheoesophageal Fistula* ; Ulcer ; Wounds and Injuries

It is reported that patients with primary hyperparathyroidism(PHPT) have disturbances in carbohydrate metabolism: in particular, hyperinsulinemia and insulin resistance are characteristic early metabolic aberrations of this disease. However, it is not clear whether changes of insulin secretion or insulin sensitivity are observed in all patients with PHPT, including those with normal glucose tolerance. Also, it is not clear whether these changes are reversible after surgical correction of PHPT. In the present study, glucose tolerance and insulin secretion were evaluated in 2 symptomatic patients with PHPT during 100g oral glucose tolerance test before and after parathyroid adenoma removal. Comparing these patients before and after surgery, glucose tolerance was not significantly different. However, C-peptide and insulin secretion was low after surgical correction of PHPT compared to the preoperative situation. This observation suggests that insulin hypersecretion in patients with PHPT precedes glucose intolerance and this early disturbance is reversible after surgery.
C-Peptide ; Carbohydrate Metabolism ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hyperinsulinism ; Hyperparathyroidism, Primary ; Insulin Resistance ; Insulin ; Parathyroid Neoplasms

Purpose: Proton beam therapy (PBT) is a state-of-the-art technology employed in radiotherapy (RT) for cancer patients. This study characterized how PBT has been used in clinical practice in Korea. Materials and Methods: Patients who received any type of RT between 2007 and 2019 were identified from the radiation oncology registry of the two PBT facilities operating in Korea (National Cancer Center and Samsung Medical Center). The chi-square test was used to identify patient- and treatment-related characteristics associated with the receipt of PBT. Results: A total of 54,035 patients had been treated with some form of RT in the two institutions, of whom 5,398 received PBT (10.0%). The number of patients who receive PBT has gradually increased since PBT first started, from 162 patients in 2007 to 1,304 patients in 2019. Among all types of cancer, PBT use in liver cancer has been steadily increasing from 20% in 2008-2009 to 32% in 2018-2019. In contrast, that in prostate cancer has been continuously decreasing from 20% in 2008-2009 to < 10% in 2018-2019. Male sex, very young or old age, stage I-II disease, residency in non-capital areas, a definitive setting, a curative treatment aim, enrollment in a clinical trial, re-irradiation and insurance coverage were significantly associated with the receipt of PBT (all p < 0.05). Conclusion Since PBT started in Korea, the number of patients receiving PBT has increased to more than 1,000 per year and treatment indications have expanded. Liver cancer is the most common primary tumor among all PBT cases in Korea.

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.
Acute Disease ; Hernia, Diaphragmatic/*complications ; Humans ; Male ; Middle Aged ; Stomach Volvulus/diagnosis/*etiology

Thoracoscopic sympathectomy is a common technique used to treat plamar hyperhiodrosis. The complications of thoracoscopic sympathectomy are rare. Recently, we experienced a complex regional pain syndrome(CRPS) after thoracoscopic sympathecotomy in a patient with hyperhidrosis. The treatment of this complication was chemical epidural sympathetic block and conservative pain control. The result of this treatment was good. The patient was recovered after one month.
Humans ; Hyperhidrosis* ; Pain, Postoperative ; Sympathectomy* ; Thoracoscopy