Background: To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency. Methods: We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39–75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts. Results: The modified HHS improved from an average of 55.04 (range, 25–79.5) preoperatively to 90.1 (range, 81–93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9–17.8 years). The radiographic analysis revealed stable stems.Femoral stems showed an average subsidence of 3.2 mm (range, 2–8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting. Conclusions Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.

Long QT Syndrome is characterized by syncope and fatal ventricular arrhythmia. Monotherapy with beta blockers is the first-line therapy. In patients with recurrent syncope despite therapy with beta blockers, combinations of the following modalities of treatment may be considered: pacemakers, left cervicothoracic sympathectomy, and implantable cardioverter defibrillators. Recently, we anesthetized a patient with Long QT Syndrome who underwent thoracoscopic left upper ganglionectomy for recurrent episodes of syncope and ventricular arrhythmia despite aggressive use of propranolol. Because of the increased risk of developing fatal ventricular arrhythmias during anesthesia and surgery, we performed a left stellate ganglion block prior to induction of anesthesia to prevent the ventricular arrhythmia that may be triggered by stimulation of the sympathetic nervous system and to assess the effect of surgical ganglionectomy on the QT interval. Following the block, the QT interval was shortened, and anesthesia and surgery was uneventful though anesthetic induction caused serious sympathetic responses. We recommend a left stellate ganglion block prior to induction of anesthesia in patients with Long QT Syndrome resistant to beta blocker to prevent fatal arrhythmia and to predict the efficacy of the surgical sympathectomy on the QT interval.
Anesthesia* ; Arrhythmias, Cardiac ; Defibrillators, Implantable ; Ganglionectomy ; Humans ; Long QT Syndrome* ; Propranolol ; Stellate Ganglion* ; Sympathectomy* ; Sympathetic Nervous System ; Syncope

No abstract available.
Foot ; Hand

Methotrexate (MTX) has been widely used in the treatment of psoriasis and rheumatoid arthritis. But prolonged use of MTX can induce hepatic fibrosis and even cirrhosis. To date, in Korea, there have been very few reports on hepatotoxicity due to MTX, and no report on biopsy-proven chronic active hapatitis. We report one patient who developed chronic acitve hepatitis while taking long-term daily dose of MTX(10mg per day) for psoriasis for a prolonged period.
Arthritis, Rheumatoid ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Korea ; Methotrexate* ; Psoriasis*

Internal fixation using a cephalomedullary nail as treatment for proximal femur fracture has recently been popular for early ambulation and rehabilitation. However metal breakage at the lag screw insertion site was reported due to non-union, delayed-union, and early weight bearing. In our orthopedic department, we experienced 2 cases of nail breakage at the lag screw insertion site, therefore we report on evaluation of the cause of metal failure and prevention of complications with literature review.
Early Ambulation ; Femur* ; Orthopedics ; Rehabilitation ; Weight-Bearing

PURPOSE: A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. MATERIALS AND METHODS: Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. RESULTS: In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0–21.1 mm), which showed insertion point of < 25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1–16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3–10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P < 0.05). CONCLUSION: In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.
Aged ; Arthritis ; Femoral Fractures ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Humans ; Methods ; Neck ; Ontario ; Radiography

BACKGROUND: Metastatic skin cancers are relatively uncommon, however, may forcast the diagnosis of internal malignancy. Therefore, early recognition can contribute to proper management. OBJECTIVE: We studied patients with metastatic skin cancer to find out average age, gender distribution, frequency of primary tumor, time interval between manifestation and primary cancer, and their clinical appearance, location, other metastatic sites and survival time. METHODS: We reviewed the medical records, clinical photographs and histopathologic records of 80 patients who had been diagnosed with metastatic skin cancer at the department of dermatology and pathology in Chonbuk National University Hospital during the last 19 years from January 1986 to December 2004. RESULTS: The mean age at the time of diagnosis was 58.8 years. The ratio of men to women was 1.05:1. The most frequent primary tumors were breast cancer (20.0%), lung cancer (15.0%), colorectal cancer (8.8%), head and neck cancer (8.8%), and gastric cancer (8.8%). Lung cancer in men and breast cancer in women were the most common primary cancers. The sites of metastatic skin cancer were widespread over the whole body. However, the abdomen and chest were the most common sites for metastases, because most cutaneous metastases occur at body regions near the primary tumor. Metastatic skin cancers usually presented as discrete, painless, hard nodules, with sudden onset. However, we also found ulcers, inflammatory patches, plaques and cystic masses as clinical manifestations of metastatic skin cancer. The mean interval time between manifestation and primary tumor was 23.5 months. Histopathological findings indicated that adenocarcinoma was the most common pathologic type, followed by squamous carcinoma, melanoma and small cell carcinoma. Metastatic skin cancers revealed grave prognosis. The mean survival time after diagnosis of metastatic skin cancer was 9.9 months. CONCLUSION: The incidence of metastatic skin cancer was much lower than in western countries, maybe because of genetic and racial differences. Overall incidence of common metastatic skin cancer was similar to that found in the literature, but our results showed a periodic difference according to primary cancer type, other organs metastasized, plus mean survival rate was 9.9 months, thereby confirming a poor prognosis of metastatic skin cancer.
Abdomen ; Adenocarcinoma ; Body Regions ; Breast Neoplasms ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Colorectal Neoplasms ; Dermatology ; Diagnosis ; Female ; Head and Neck Neoplasms ; Humans ; Incidence ; Jeollabuk-do ; Lung Neoplasms ; Male ; Medical Records ; Melanoma ; Neoplasm Metastasis ; Pathology ; Prognosis ; Skin Neoplasms* ; Skin* ; Stomach Neoplasms ; Survival Rate ; Thorax ; Ulcer

No abstract available.
Hernia, Hiatal* ; Humans ; Infant, Newborn*

Transcatheter arterial embolization (TAE) is widely used in the treatment of unresectable hepatocellular carcinoma. Its common complications are right upper quadrant pain, nausea, vomiting, and rare complications include focal pancreatic necrosis, gastric ulcer, renal failure, DIC, biliary tree necrosis and splenic infarction and so on. It has been reported that hepatobronchial fistula could develop as a pleuropulmonary complication of liver abscess. We report a case of hepatobronchial fistula caused by complicating liver abscess in a patient with hepatocellular carcinoma who was treated with TAE.
Biliary Tract ; Carcinoma, Hepatocellular* ; Dacarbazine ; Fistula* ; Humans ; Liver Abscess ; Nausea ; Necrosis ; Renal Insufficiency ; Splenic Infarction ; Stomach Ulcer ; Vomiting

Papillary eccrine adenoma is a rare benign sweat gland neoplasm. It occurs most often as a solitary nodule in women and is located predominantly on the distal portion of the extremities. This tumor is similar to tubular apocrine adenoma in histological and clinical aspects, so distinction of these tumors is still controversial. We report a case of two papillary eccrine adenomas developed on the left popliteal and calf area of a 58-year-old-man, this is the first report of the multiple papillary eccrine adenomas in Korea.
Adenoma* ; Extremities ; Female ; Humans ; Korea ; Sweat Gland Neoplasms