Fracture of the scaphoid constitute 60% to 70% of all diagnosed carpal injury. The acute fracture will heal approximately 90% of the time if recognized early and properly immobilized. But nonunion are common since the symtoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Authors have experienced 19 cases of scaphoid nonunion and accomplished good result in all case by Russe procedure. The results were summerized as follow: 1 The cause of fratures was mainly due to fall down dinjury (36.8%). 2. The most common mechanism of the fracture was fall on the outstretched hand (52.7%). 3. Fractures were shown on the anterior-posterior, lateral and billiards view in all cases. 4. In ten cases, the fractures were found on the waist of scaphoid. 5. The cases of nonunion were probably inadequate intial treatment and delayed diagnosis. 6. The good results were obtained by bone graft according to Russe procedure.
Delayed Diagnosis ; Diagnosis ; Hand ; Humans ; Transplants

Dislocation involving tarsal navicular is a extremely rare injury compare to dislocation of other tarsal bone. One case of the tarsal navicular dislocation associated with subluxation of the midtarsal joint treated by open reduction and arthrodesis was reported.
Arthrodesis ; Dislocations ; Joints ; Tarsal Bones

BACKGROUND: Oncogenes and EGF-Receptor(EGFR) may be involved n different stages of the multistep carcinogenesis process. A specific pattern of karyotypic abnormalities in solid tumors can be detected by cytogenetic methods. OBJECTIVE: This study is intnded to observe the cytomolecular kiologic chracterization of c-myc, erb B and EGFR genes in squasnous cell carcinoma(SCC) of the skin and cervix. METHODS: We have eytogenet,ically examined the short-term culturs from SCC. The rearrangement, amplification or expressi.on of erb B, c-myc, and EGFR genes were studied by Southern blot, analysis of genomic DNA and by slot blot analysis of tota! RNA extracted from biopsies of normal skin and SCC tissues. EGFR expression was examined immunohistochemially using monoclonal antibodies and the localizat,ion of the c-myc oncogene mRNA by in situ hybridization. RESULTS: A remarkably structural aberration was del 6(q21-qter) counted 20 metaphases among 28 metaphases ana1yzed. In nunierical aberration, all chromosomes were lost or gained randomly. Amenploid including triploid and tetraploid were observed in 8 metaphases, 6 tumor cells contained marker chromosome. In Southern blot analysis, rearrangement and amglificaton of EGFR in primary squamous cell carcinoma of cervix uteri and skin respectively. In slot blot analysis, the levels of c-myc, erb B and EGFR mRNA increaaed respectively 3.5, 2.5 and 2.8 times in SCC when compared to normal tissues. In immunoperoxidase stain, EGFR was present, in SCC where keratinocytes with strong cyto-plasmic staining but no membr, line labelling, where as in normal skin the were primarily present in t,he membrane and cytoplasm of basal cells. In situ hybridization with c-myc cDNAs allowed detection of grains representative of biotin labelled cDNA-mRNA hybrids in the frozden section of SCC tissues. CONCLUSION: These results suggest that specific patterns of karyotypir abnormalites, rearrangement, or amplification of EGFR gene, and overexpression of oncogenes and EGFR gene may be associated with the carcinogenesis of SCC.
Antibodies, Monoclonal ; Biopsy ; Biotin ; Blotting, Southern ; Carcinogenesis ; Carcinoma, Squamous Cell* ; Edible Grain ; Cervix Uteri ; Cytogenetics ; Cytoplasm ; DNA ; DNA, Complementary ; Epidermal Growth Factor* ; Female ; Genes, erbB-1 ; In Situ Hybridization ; Keratinocytes ; Membranes ; Metaphase ; Oncogenes ; RNA ; RNA, Messenger ; Skin ; Tetraploidy ; Triploidy

Objective: Previous studies have reported the presence of a “weekend effect” with respect to mortality in serious emergency admissions, including cases of traumatic brain injury (TBI).However, the relationship between weekend hospitalization and TBI mortality has not been fully established. This study aimed to conduct a systematic review of available evidence and investigate differences in mortality among TBI patients between weekday and weekend admissions. Methods: Electronic databases including PubMed, Cochrane Library, and Embase were used to obtain relevant articles. Mortality, as the primary outcome of interest, encompassed inhospital or 30-day mortality. Mortality rates were compared between the 2 groups, weekend and weekday admissions. Additionally, meta-regression analysis was performed on potential confounders to verify and provide comparative results. Results: A total of 7 studies involving 522,942 TBI patients were eligible for inclusion in the synthesis of the systematic review. Of these patients, 71.6% were admitted during weekdays, whereas 28.4% were hospitalized on weekends. The overall integrated mortality was 11.0% (57,286/522,942), with a mortality rate of 10.8% in the weekday group and 11.3% in the weekend group. Pooled analysis revealed no significant difference in mortality between the weekday and weekend groups (risk ratio, 0.99; 95% confidence interval, 0.90–1.09; p=0.78).Furthermore, the meta-regression analysis for sensitivity assessment showed no modifying effect on mortality (p=0.79). Conclusion This study found no difference in mortality rates between weekday and weekend admissions among TBI patients. Additional sensitivity analyses also demonstrated no significant increase in the risk of mortality in the weekend group.

No abstract available
Mycosis Fungoides*

BACKGROUND: In orthostatic headache (OH) associated with low cerebrospinal fluid (CSF) pressure, loss of CSF vol-ume reflected by pachymeningeal enhancement (PCE) on brain magnetic resonance image (MRI) has been suggested as a pathogenenesis according to Monro-Kellie rule. We attempted to test the following hypotheses; 1) OH is caused by loss of CSF volume, 2) CSF volume loss in OH is caused by hyperabsorption of CSF or 3) by decreased production of CSF. METHODS: Nineteen patients with OH were recruited. Lumbar puncture, brain MRI and radioisotope cisternogra-phy (RIC) were performed in all of them. We evaluated duration of headache from onset to first evaluation, presence of PCE on MRI and CSF leakage (CSFL) on RIC. Firstly, we compared duration of headache between patients with and without PCE. Secondly, between those with and without PCE, we analyzed presence of CSF fistula and demonstration of CSFL on RIC. RESULTS: Mean duration (16.1 +/-19.6) of headache in 13 patients with PCE (66.7%) was significantly longer than in those without PCE (P=0.036). Among 19 patients, CSF fistula was detected in 13 patients (72%) and CSFL in 16 patients (88.9%). There was no significant difference in CSF fistula presence (P=0.114) and in demonstra-tion of CSFL between those with and without PCE. In 16 patients, delayed appearance of radioisotope along cerebral interhemispheric and sylvian regions was shown on RIC. CONCLUSIONS: Pain in OH may be caused by CSF volume loss, however, whether CSF volume loss is caused by CSF hyperabsorption or decreased production remains to be clarified.
Brain* ; Cerebrospinal Fluid ; Fistula ; Headache* ; Humans ; Magnetic Resonance Imaging* ; Spinal Puncture

OBJECTIVES: Contemporary empirical studies have suggested high rates of comorbid attention-deficit hyperactivity disorder(ADHD) or obsessive compulsive disorder(OCD) in children with tic disorders. Not infrequently, ADHD or OCD is as source of greater impairment than are the tic symptoms. The studies in the pathophysiology of tic disorder have implicated abnormalities of dopamine, serotonin and norepinephrine. The studies in pathophysiology of ADHD or OCD also have implicated abnormalities of dopamine, serotonin and norepinephrine. This study was purposed to examine the differences in tic severities and in the levels of plasma homovanillic acid(HVA) and 5-hydroxyin-doleacetic acid(5-HIAA) according to the presence of comorbid ADHD or OCD in patients with chronic tic disorders. METHODS: In fifty chronic tic patients, OCD or ADHD was also diagnosed. And then tic symptoms, obsessive-compulsive symptoms, and attention-deficit hyperactive symptoms were assessed using Yale global tic severity scale(YGTSS), Leyton obsessional inventory-child version(LOI-CV), and Conners parent rating scale. The plasma HVA and 5-HIAA levels were measured using high performance liquid chromatography with electrochemical detection method. RESULTS: Fifty-eight percent of the patients with chronic tic disorders had comorbid ADHD or OCD. But severities of tic did not differ regardless of the presence of comorbid ADHD or OCD. There was a significant positive correlation between tic severities and plasma HVA levels but none between tic severities and plasma 5-HIAA levels. There was a significant inverse correlation between resistance and interference scores and plasma 5-HIAA levels. Plasma HVA levels showed significant positive correlations with plasma 5-HIAA levels. CONCLUSION: These results showed that tic severities didn't vary according to the presence of comorbidities, and that tic severities were correlated with plasma HVA levels, not with plasma 5-HIAA levels. These results suggested that the pathophysiology of chronic tic disorder was strongly correlated with abnormalities of dopaminergic system.
Child ; Chromatography, Liquid ; Comorbidity* ; Dopamine ; Homovanillic Acid* ; Humans ; Hydroxyindoleacetic Acid ; Norepinephrine ; Obsessive Behavior ; Obsessive-Compulsive Disorder ; Parents ; Plasma* ; Serotonin ; Tic Disorders* ; Tics*

Spontaneous rupture of subcapsular liver hematoma in pregnancy is rare but potential life threatening complication of preeclampsia. We experienced a case of spontaneous rupture of subcapsular hematoma of liver that was treated with conservative method. So, we present the case with a brief review of literatures as first report in Korea.
Hematoma* ; Korea ; Liver* ; Pre-Eclampsia ; Pregnancy* ; Rupture, Spontaneous

BACKGROUND: Since 1985 when ILAE proposed its first classification system of epilepsy, many studies have reported the practical applicability of the system. However, its limitations have been elucidated. In order to find out the applicability and limitations of the ILAE classification system and the role that diagnostic parameters (semiology, EEG and MRI) take in the anatomical localization of localization-related epilepsies (LREs), we investigated the clinical data of adult patients with LRE in step-wise way. METHOD: We recruited 173 patients with newly-referred/diagnosed LRE from our departmental data registry. Idiopathic epilepsies were excluded. We evaluated the anatomical localization rate(LR) according to each diagnostic parameter, the concordant localization rate(CLR) between two parameters and between three parameters. LR in total patients by any one of three diagnostic parameters was also evaluated. MRI abnormalities were evaluated in those patients showing concordant localization between semiology and EEG. RESULTS: The highest anatomical LR(67.1%) was reported in the semiological parameter. CLR between semiology and EEG was 28.9%. CLR between three parameters was 16.2%. MRI abnormalities were seen in 60% of patients with concordant localization between semiology and EEG. Fifty six percent of electroclinically concordant patients showed concordant localization with an MRI and 79% of them were concordantly localized in the temporal lobe. The LR in total patients was 71.7%. In each of the evaluation steps, the temporal lobe LR was the highest. CONCLUSIONS: Total lobar LR by any one diagnostic parameter in all the patients was high according to the ILAE diagnostic criteria. Semiology was the best localizing parameter, however, combined evaluation with either EEG or MRI reduced the localizability. Even though the MRI study showed a significant discordance rate in patients with electroclinical localizations, it could identify the underlying etiology in a major proportion of the patients. This study showed the importance of an imaging study in the lobar localization of LREs combined with an electroclinical localization by the ILAE classification system.
Adult* ; Classification* ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy* ; Humans ; Magnetic Resonance Imaging ; Temporal Lobe

BACKGROUND: Although the incidence of stroke does not decrease after 80 years of age. The significance of ischemic stroke (IS) after octogenarian age has not attracted the attention of neurologists. As a first step to investigate the significance of IS during that period, we compared the clinical characteristics of IS between OIS (octogenarian ischemic stroke group, ??80 years of age) and NOIS (non-octogenarian ischemic stroke group, 65-79 years of age). METHOD: Forty-nine OIS patients and 141 NOIS patients were recruited. Clinical characteristics including risk factors, IS subtype, Canadian Neurological Scale (CNS) score, treatment modality and short-term prognosis were evaluated and described. RESULTS: ypertension (65.3%) was the most common risk factor followed by smoking (28.6%) and previous stroke history (28.6%) in OIS. There was no significant difference in proportion of each IS risk factors between he two groups. OIS was more associated with subtypes of mixed etiology and cardiogenic embolism than NOIS (P<.05). Subclassification by the vascular territory of IS was similar between the two groups and the middle cerebral arterial territory was the most common site (71.1%) in OIS. CNS scores on the initial neurological examination was similarly associated with both OIS (8.0 3.3) and NOIS (7.5 2.8)(P>.05). IS was more associated with poor outcome at discharge (52.2%) than NOIS (18.2%)(P<.05). CONCLUSIONS: Ischemic stroke after octogenarian age is characterized by different etiopathogenesis and poor short-term outcome compared to IS under that age. OIS is more frequently caused by cardiogenic embolism or combined underlying etiology, however, the relationship between differences in etiopatho-genesis and poor short-term outcome remains to be clarified.
Aged, 80 and over* ; Embolism ; Humans ; Incidence ; Neurologic Examination ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Stroke*