Extramammary Paget's disease is a rare malignant disease associated with underlying adenocarcinoma, or not. Two cases with a unique clinical presentation are described and we wish to call attention to the malignant potential of chronic scaly and erythematous lesions of perianal and genital area.
Adenocarcinoma ; Male ; Paget Disease, Extramammary* ; Penis* ; Scrotum*

The flexor tendon injuries of the finger are very difficult to treat satisfactorily. Early treatment is desirable, but not always posaible. In addition, joint stiffness and limitation in gliding of the tendon caused by adhesion, make the problem more complex. From 1978 until 1988, 13 patients (14 eases) underwent operations for free tendon graft, and 10 patients (13 eases) for staged tendon graft at the Department of Orthopaedic Surgery, National Medieal Center. They have been followed up for clinical study, and the result was summarized as follows:1. Old flexor tendon injuries were common in the teen and twenties, especially in male. 2. They occurred in the index (10 Cases, 37.0%) and middle (8 cases, 29.6%) fingers most commony, especially zone II (62.9%). 3. The result was evalusted according to the method designed by Strickland and Glovac. In 19 out of 27 cases, satisfactory result (excellent and good) was yielded. 4. In cause, deep laceration by sharp object was better in the result than crushing injury. 5. The interval between the injury and the operation ranged from 1 month through 11 years, averaging 16 months, and is supposed to have little relation to the result. 6. The preoperative state is supposed to have much relation to postoperative result, judging from 100% of satisfactory result in Grade I compared with 40% in Grade V according to Boyes preoperative classification. 7. Little difference is seen in the result between free tendon graft and staged tendon graft. And 5 cases complicated by adhesion, rupture of grafted tendon and wound infection yielded poor result.
Adolescent ; Classification ; Clinical Study ; Fingers ; Hand ; Humans ; Joints ; Lacerations ; Male ; Methods ; Rupture ; Tendon Injuries ; Tendons ; Transplants ; Wound Infection

Cysts of the meniscus are rare lesion of the knee. They may present as a local tumor or mimic signs of an internal derangement of the knee. So it is difficult to diagnose and apt to overlook in physical examination. Also they almost always have combined pathology of the involved meniscus, such as, meniscal tear or discoid meniscus. The pathologic basis of the meniscal cyst is controversial, but rece 2. Most of the patients had tear of the involved meniscus, but the patients with discoid meniscus did not have gross tears or previous trauma history. nt works suggest the etiology is infiltration of joint fluid through micro and macro tears in the meniscus. In the past, complete excision of the meniscus as well as cyst was thought to be the treatment of choice to prevent recurrences. But nowadays, the trend is changed as preserving the involved meniscus, when no tear of the meniscus is found to prevent enevitable degenerative changes after total meniscectomy. We experienced 6 cases of meniscal cyst during recent 2 years and obtained following results. 1. Precise joint line evaluation is much more important in the diagnosis of the meniscal cyst before making special study. 2. Most of the patients had tears of the involved meniscus, but the patients with discoid meniscus did not have gross tears or previous trauma history. 3. When the cyst is located anteriorly in the joint line, it is prominent in flexed position of the knee; and when located posteriorly, prominent in extended position of the knee. 4. Excision of the cyst and reattachment of the meniscus were thought to be good method when the cyst was located in the parameinscal area without gross tear of the involved meniscus.
Diagnosis ; Humans ; Joints ; Knee ; Methods ; Pathology ; Physical Examination ; Recurrence ; Tears

In management of foot deformity, the operative procedures such as tendon transplantation and bone stabilization are of the relatively recent origin. The first tendon transfer was performed by Nicoladoni in 1881. Since that original report, a voluminous literature was appeared on the subject of tendon trasplantation. During the period, from Jan. 1960 to May. 1992, we have done clinical studies of the 189 feet on 167 patients who had been undergone tendon transfer. The results are as followes, 1. Residual poliomyelitis, leprosy, cerebral palsy and club foot are common etiology. Among them, residual poliomyelitis was the most common, especially in 1960 to 1969. Recently trauma and aged leprosy were increased. 2. Among 189 feet, the equinovaurs deformities were 90 cases. 3. Posterior tibial tendon, peroneus tendons, anterior tibial tendon, Achilles tendon and extensor hallucis tendon were transferred. 4. Posterior tibial tendon was mostly used. 5. The evaluation for surgery, for Good to Excellent was 114 feet 60. 3% 6. The poor results were noticed in the cases of the calcaneal deformity and showed in the age below 5 years old.
Achilles Tendon ; Cerebral Palsy ; Congenital Abnormalities ; Foot Deformities ; Foot ; Humans ; Leprosy ; Poliomyelitis ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons

The anterior decompression and anterior interbody fusion have been the choice of surgical treatment for spinal tuberculosis since 1960. But, multi-level spinal tuberculosis involved more than three vertebrae resulted in large post-debridement defect and spinal instability. So, failure of the graft was very common & postoperative maintenance of the kyphotic angle correction was very difficult. In part of such cases as multi-level spinal tuberculosis, we performed supplementary anterior instrumentation in a single-stage procedure. The authors analyzed total 39 surgical cases of multi-level tuberculosis of the thoracolumbar spine from January 1985 to June 1992. The patients treated only with a strut graft were designated as group I(n=23) and the patients added by anterior instrumentation as group II(n=16). Mean age of 39 cases was 33.1 years, and mean follow-up period was 31.6 months. The purpose of this study was to compare the postoperative results of group I with those of group II by measuring the angular kyphosis on serial lateral roentgenograms, and to provide an aid in selecting method of surgery before treatment of multi-level spinal tuberculosis with high risk of progression of kyphosis. The results were as follows: 1. There were 16 cases of thoracolumbar, 14 cases of thoracic, 9 cases of lower lumbar lesions, and numbers of vertebrae involved were 4.2 in mean. 2. By standard Cobb lateral measurement, mean preoperative angle of segmental kyphosis was 32.5° in group I, and 45.1° in group II, and group II proved as more kyphotic. After operation, mean angle of segmental kyphosis was 24.7° in group I and 32.4° in group II. 3. On final F/U, mean angle of segmental kyphos was 32.7° in group I, and 37.3° in group II, and final loss of correction was 8.0° in group I, 4.9° in group II. 4. There were 8 patients(34.8%) of graft-related complications in Group I, and 2(12.5%) in group II. And graft failure in group I resulted in severe loss of correction of segmental kyphosis, but graft failure in group II did not, through graft protection by anterior instrumentation. 5. There were 3 patients(18.8%) of implant-related problems in group II; two during and one after union. In these former two cases, bony union was obtained without loss of correction by prolonged application of brace. No cases of group II was associated with persistence or recurrence of infection after instrumentation. In our opinion, anterior interbody fusion and combined anterior instrumentation can be effective and safe one of methods in surgical treatment for multi-level tuberculosis of the spine which has been considered as the most important determinant of the result by its extensive vertebral involvement with resulting large post-debridement defect to be struted.
Braces ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Methods ; Recurrence ; Spine ; Transplants ; Tuberculosis ; Tuberculosis, Spinal

Vertebral stabilization using transpedicular screw fixation device is widely used in the surgical treatment of degenerative lumber diseases such as spinal stenosis, pseudospondylolisthesis, and spinal instability. The use of transpedicular screw fixation devices provides substantial advantages with regard to an increase of the rate of solid arthrodesis, early rehabilitation, short segment spinal fusion, and restoration of sagittal lumbar lordosis. The authors analyzed 11 patients showing definite postoperative loss of the lumbar sagittal lordosis in a total of 110 surgical cases of degenerative lumbar diseases who underwent segmental spinal fusion using transpedicular screws from January 1981 to December 1993. The purpose of this study was to analyze the causes of loss of lumbar sagittal lordosis in the instrumented segments and to present some precautions in transpedicular screw fixation for surgical patients with degenerative lumbar spines to maintain corrected lumbar sagittal lordosis. The results from this study were as follows: 1. By standard Cobb lateral measurements, eleven cases in a total of 110 patients showed definite loss of lumbar sagittal lordosis more than 4 degrees. 2. The period reflecting loss of lordosis was roughly within postoperative four months which were critical fusion time of the grafted bone mass, which lasted an average of 4.8 months in this study. 3. The implants led to loss of lordosis consisted of 6 cases in 53 Diapasons, 4 cases in 32 Wiltses, and a case in 15 Steffee plate systems. Diapason & Steffee plate systems were classified as a rigid type and Wiltse system as a flexible one. 4. The causes of postoperative loss of lordosis were recognized as 2 cases of screw toggling, 5 cases of screw-rod locking failure and 4 cases of rod bending. 5. The group resulted in more loss of lordosis in degrees was related to significant change between preoperative and postoperative lordosis, distraction of disc space during operation, extensive discectomy, and reduction of degenerative spondylolisthesis which were the cases of the anterior column deficiency.
Animals ; Arthrodesis ; Diskectomy ; Humans ; Lordosis ; Rehabilitation ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Transplants

PURPOSE: Current evidence indicates that ultrasonography of the breast is an important adjunct to mammography and clinical examination in the diagnosis of palpable breast abnormalities. An assessment of the value of office-based ultrasonography of a palpable breast mass performed by a breast surgeon was the aim of this work. METHODS: A 7.5 MHz linear probe was used to perform office-based ultrasonography in 109 consecutive female patients having a palpable solid breast mass between August 1998 and December 1999. Breast masses diagnosed histologically as fibroadenomas or breast cancer were included in this study. The clinical impression from the physical examination (PE), the result of officed-based ultrasonography done by a surgeon (OUSG), and comprehensive judgement engaging both PE and OUSG (PEUSG) were recorded in each patient's hospital record as benign or malignant at the first visit. The diagnostic values of PE, OUSG, PEUSG, mammography (MMG), and ultrasonography done by a radiologist (USG) were compared. RESULTS: Of 109 masses, a fibroadenoma was diagnosed in 73 patients while a carcinoma was established in 36 patients. The sensitivity, the specificity, the accuracy rate, and the kappa coefficient were 91.7%, 89.0%, 89.9%, and 0.780 for PE; 100%, 90.4%, 93.6%, and 0.862 for OUSG; 97.2%, 97.3%, 97.2%, and 0.938 for PEUSG; 90.4%, 89.4%, 90%, and 0.630 for MMG; and 88.9%, 90.9%, 90% and 0.798 for USG. The diagnostic accuracy of PEUSG was significantly higher than those of PE and MG (p<0.05). CONCLUSION: These data suggest that office-based ultrasonography of the breast performed by a surgeon is a useful adjunct to clinical evaluation of the breast mass and permits timely and cost-effective patient care.
Breast Neoplasms ; Breast* ; Diagnosis* ; Female ; Fibroadenoma ; Hospital Records ; Humans ; Mammography ; Patient Care ; Physical Examination ; Prospective Studies* ; Sensitivity and Specificity ; Ultrasonography*

Opposition of the thumb is necessary for pinch-one of the three most important functions of the hand. Frequently, opposition is either partially or totally lost in poliomyelitis or median nerve palsy. Several types of operations have been devised for restoration of opposition, and in 1973, Burkhalter et al. announced extensor indicis proprius opponensplasty: the tendon of extensor indicis proprius is brought out in the area of the pisiform and then passed against subcutaneously across the palm to the thumb, being attached to the abductor pollicis brevis and extensor pollicis longus tendon. It is useful in the case of loss of opposition without available finger flexor or wrist motors. Of nine patients who underwent operation-one with Riordan and eight with Burkhalter type of opponensplasty-at National Medical Center, seven had excellent results: one had a fair, and another one had a poor result. Six patients were with low combined median and ulnar nerve injury: one with high combined median and ulnar nerve injury: one with brachial plexus injury: and one with myotmesis of the thenar muscles. From the results, we conclude that Burkhalter type of opponensplasty makes satisfactory result for the hand without opposition movement; it is indicated in high median nerve injury and any combined median and ulnar nerve injury6; early restoration of opposition to the thumb in median nerve injury and in those limbs with multiple tissue trauma adds immeasurably to the over-all early rehabilitative effort.
Brachial Plexus ; Extremities ; Fingers ; Hand ; Humans ; Median Nerve ; Muscles ; Paralysis ; Poliomyelitis ; Tendons ; Thumb ; Ulnar Nerve ; Wrist

Ganglia are the most common soft tissue tumors of the hand. Ganglia found on the dorsum of the wrist usually arise from the scapholunate ligament and are usually located between the extensor digitorum communis tendon of the index finger and extensor pollicis longus tendon. Intratendinous ganglion is a very rare lesion of unknown etiology and natural history that originates within the tendon. A patient is described who presented with a painful mass on the dorsolateral aspect of the wrist due to an intratendinous ganglion of the extensor pollicis longus tendon. Treatment consisted of excision of the extensor pollicis longus tendon with ganglion followed by mini free tendon graft using palmaris longus tendon.
Fingers ; Ganglia ; Ganglion Cysts ; Hand ; Humans ; Ligaments ; Natural History ; Tendons ; Transplants ; Wrist

OBJECTIVE: We analyzed the main causes leading to a poor outcome (severe disability, a vegetative state and death) following surgical treatment for ruptured intracerbral aneurysms. METHODS: Between January 1994 and December 2007, we maintained a retrospective database of 339 patients who underwent surgical clipping. The various causes we investigated were the technical problems during operation, the initial SAH or ICH, vasospasm, hydrocephalus and the post-operative medical complications. The clinical outcome was assessed according to the Glasgow Coma Scale (GOS). RESULTS: There were 263 cases of good outcomes (77.6%) and 76 cases of poor outcomes (22.4%). The three main causes of a poor outcome were 1) preoperative causes such as the direct insult of the initial SAH and ICH in 21 cases (27.6%), 2) intra-operative causes such as the technical problems during dissection and clipping of the aneurysm neck in 29 cases (38.2%) and 3) postoperative causes such as clinical vasospasm in 16 cases (21.1%). The mean follow-up period was 17.6 months (range : 2 months to 9 years). CONCLUSION: A meticulous neck dissection and complete obliteration of the aneurysm preserving parent arteries and perforators are the most effective and prime methods that surgeons can employ to reduce the rate of poor outcomes when performing ruptured aneurysm surgery.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Microsurgery ; Neck ; Neck Dissection ; Parents ; Persistent Vegetative State ; Retrospective Studies ; Surgical Instruments