Since 1985, authors have applied a cast ring around the reconstructed pully involving adjacent one normal digit and allowed early dynamic motion after one stage tenolysis or tendon graft in 24 digits of 16 patients with old flexor tendon injuries in zone II. With this ring technique, authors obtained satisfactory results in 80% of the patients, which proved to be as good as two stage flexor tendon reconstruction with silicone rodding. A cast ring allowed early active motion after tenolysis and early dynamic passive motion after tendon graft. It served as temporary external augmentation of the reconstructed pully and seemed to reduce the tension at the reconstruced tendon and pully. One stage flexor tendon reconstruction and early dynamic motion with ring technique was advantageous in shortening of morbidity and postoperative rehabilitation period, and eliminating complications from silicone rodding.
Humans ; Rehabilitation ; Silicon ; Silicones ; Tendon Injuries ; Tendons ; Transplants

Acid ingestion causes a coagulative necrosis of the surface epithelium of the upper gastromtestinal tract. Its late sequence is luminal stenosis which frequently requires surgical repair. Nevertherless, in many cases, non-operative dilatation of luminal stenosis have been applicated, such as bouginations, balloon dilatations, endoscopic laser therapy, endoscopic electrocoagulation, endescopic microwave coagulation. These methods may give some considerable benefits in unoperable cases. Recently, we experienced a case of a 60-year-old man who had severe corrosive esophageal and gastric angular strictures by accidentally ingested hydrochloric acid and after many tiems of application of non-operative dilatation was able to have normal diet without dysphagia. So, we report this case with a review of literatures.
Constriction, Pathologic* ; Deglutition Disorders ; Diet ; Dilatation* ; Eating ; Electrocoagulation ; Epithelium ; Humans ; Hydrochloric Acid ; Laser Therapy ; Microwaves ; Middle Aged ; Necrosis ; Phenobarbital

To evaluate the value of MR imaging in the examination of ligament injury of the knee, we retrospectively analysed the MR images of 61 injured knees of 60 patients. The presence of tear was determined by arthroscopy in all cases. Anterior/posterior cruciate ligaments(ACL/PCL) were demonstrated by sagittal images. Media/lateral collateral ligaments(MCL/LCL) were evaluated on coronal images. The diagnostic accuracy were 91.8%, 96.7% and 100% for ACL, PCL and MCL, respectively. The specificity for the lateral collateral ligament was 100%. It is concluded that magnetic resonance imaging is an accurate method in detecting injury of the ligaments of the knee.
Arthroscopy ; Humans ; Knee* ; Lateral Ligament, Ankle ; Ligaments* ; Magnetic Resonance Imaging ; Methods ; Retrospective Studies ; Sensitivity and Specificity ; Tears

To evaluate the role of magnetic resonance(MR) imaging in the diagnosis of the discoid meniscus, the authors reviewed 31 cases of discoid menisci diagnosed by MR imaging among which 16 cases received arthroscopy. Using knee surface coil, sagittal T1, T2, & protein density images and coronal T1 weighted images were obtained with 18 cm FOV & 4mm/1 mm thickness/gap. A discoid meniscus was considered if three or more contiguous sagittal images demonstrated continuity of the meniscus between the anterior and posterior horns or the diameter of the mid-portion of the meniscus exceeded 15 mm on the coronal image. The authors also observed the associated abnormalities including tears of meniscus and ligament, meniscal cyst, and osteochondral defects. All discoid menisci were lateral menisci and torn discoid lateral menisci were present in 26 cases(83%). In two cases, tears of the contralateral medial meniscus were present. The tears of anterior and posterior cruciate ligaments, meniscal cyst, and osteochondral defects were present in 4, 2, 4, and 5 cases respectively. All collateral ligaments were intact. In conclusion MR imaging was useful for the detection of discoid meniscus and associated abnormalities.
Animals ; Arthroscopy ; Collateral Ligaments ; Diagnosis ; Horns ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

Nerve compression syndromes can be caused by compression of the peripheral nerve from interior or exterior of the nerve. In the upper extremities, brachial plexus, ulnar nerve and median nerve can be compressed in thoracic outlet syndrome, cubital tunnel syndrome and carpal tunnel syndrome respectively. Because these syndromes are caused by compression, decompressive management can be expected to be the principle of treatment. From Jan. 1980 to Dec. 1988, 94 patients were admitted and treated for nerve compression syndromes of the upper extremities in Seoul National University Hospital. Among these, 52 patients suffered from carpal tunnel syndrome and operation was performed to 86 hands. Twelve patients suffered from thoracic outlet syndrome and 25 from cubital tunnel syndrome. Ten patients were treated with conservative method and 84 with decompressive surgery. Satisfactory results were obtained in 92.3% of carpal tunnel syndrome and 84% of cubital tunnel syndrome. Of 4 operated cases of thoracic outlet syndrome, 3 cases were satisfactory.
Brachial Plexus ; Carpal Tunnel Syndrome ; Cubital Tunnel Syndrome ; Hand ; Humans ; Median Nerve ; Methods ; Nerve Compression Syndromes ; Peripheral Nerves ; Seoul ; Thoracic Outlet Syndrome ; Ulnar Nerve ; Upper Extremity

Hemangiopericytoma is a rare vascular tumor arising from pericytes. The tumor usually develops in the skin or subcutaneous tissue, particularly in the extremities.4 pulmonary origin of hemangiopericytoma is known to be quite rare. It has the potential to become a highly malignant lesion, so wide excision is the treatment of choice. We present a case of primary malignant hemangiopericytoma of the lung and discuss the clinical symptoms, diagnosis, therapy and prognosis within the context of a brief review.
Diagnosis ; Hemangiopericytoma* ; Lung* ; Pericytes ; Prognosis ; Skin ; Subcutaneous Tissue

OBJECTIVE: To identify the risk factors for secondary lymphedema after breast cancer surgery. Lymphedema, a sequelae of breast cancer therapy, changes functional abilities and may affect a patient's psychosocial adjustment and overall quality of life. It is generally underreported and undertreated. METHOD: Six hundred two patients who had undergone breast cancer surgery between January 2000 and December 2005 were examined. The circumferences of the upper extremities were measured and lymphedema was defined as difference of greater than 2cm between the affected and normal arms. The effects of age, body mass index, diabetes, hypertension, side of tumor, sugery method, radiotherapy, chemotherapy, TNM stage, involvement of axillary lymph nodes, menopausal state and laboratory findings on the development lymphedema were investigated and analyzed by t-test, chi-square test and multiple logistic regression analysis. RESULTS: 121 out of 602 patients had lymphedema. Those patients with lymphedema had a higher body mass index. Univariate analysis indicated an increased occurrence of lymphedema due to those with body mass index, radiotherapy, T2 stage, N3 stage and axillary lymph node invasion. Multivariate analysis revealed that body mass index and radiotherapy were independently associated factors for lymphedema after breast cancer surgery. CONCLUSION: The patients who had radiotherapy or BMI greater than 25 must be considered as potential candidates to have lymphedema after breast cancer surgery. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measure, and the treatment.
Arm ; Body Mass Index ; Breast ; Breast Neoplasms ; Humans ; Hypertension ; Logistic Models ; Lymph Nodes ; Lymphedema ; Multivariate Analysis ; Quality of Life ; Risk Factors ; Upper Extremity

Tubular apocrine adenoma and papillary eccrine adenoma are rare sweat gland neoplasms that appear as a small solitary lesion on the scalp or extremities, respectively. Although these lesions are thought to be distinct entities, there are enough similarities between them to group them under the term tubulopapillary hidradenoma or papillary tubular adenoma. We describe a case showing many tubular structures with papillary projection, syringocystadenoma-like structures, and eccrine hirocystoma-like structures in the axillary area. The term of papillary tubular adenoma or tubulopapillary hidradenoma may be prefered in this case.
Acrospiroma ; Adenoma* ; Extremities ; Scalp ; Sweat Gland Neoplasms

Mitochondrial myopathy is characterized by variable clinical manifestations from mild limb weakness to fatal respiratory failure and central nervous system sequela. But it is a rare event that sleep disordered breathing become a clue of diagnosis for mitochondrial myopathy. We report a case of a 21 year-old man who was diagnosed as mitochondrial myopathy during the investigation for the possible cause of chronic hypoventilation syndrome. Before being admitted to our hospital, he was suspected as having sleep apnea syndrome in another hospital. We re-evaluated the history, physical examination, laboratoy findings and polysomnography in detail. Severe hypoxemia was noted during REM sleep on nocturnal polysomnography and the diagnosis of mitochondrial myopathy was made by muscle biopsy in rectus abdominis muscle. We treated him with bilevel positive airway pressure therapy during sleep and it could reverse the hypoxemia during REM sleep. He could be discharged with improved condition and is being well with the use of this ventilatory assistance.
Anoxia* ; Biopsy ; Central Nervous System ; Diagnosis ; Extremities ; Humans ; Hypoventilation ; Mitochondrial Myopathies* ; Physical Examination ; Polysomnography ; Rectus Abdominis ; Respiratory Insufficiency ; Sleep Apnea Syndromes ; Sleep, REM* ; Young Adult