Severe recurrent attacks of acute febrile neutrophilic dermatosis shortly followed multiple keratoacanthoma in a 43-year-old man with myelodysplastic syndrome. Besides the typical clinicopathological findings of the syndrome(fever, leukocytosis and neutrophilic erythematous plaques of the skin), the patient showed orolingual and conjunctival ulceration and severe cutaneous pathergic reactions. Moreover, to the best of our knowledge, multiple keratoacanthoma has not yet been reported with relation to the acute febrile neutrophilic dermatosis.
Adult ; Humans ; Keratoacanthoma* ; Leukocytosis ; Myelodysplastic Syndromes ; Neutrophils ; Sweet Syndrome* ; Ulcer

Supernumerary derivative (22) syndrome is a rare genomic syndrome. It is characterized by severe mental retardation, microcephaly, failure to thrive, preauricular tag or sinus, ear abnormalities, cleft and/or high-arched palate, micrognathia, kidney abnormalities, congenital heart defects, and genital abnormalities in males. In 99% of the cases, one of the parents is a balanced carrier of a translocation between chromosome 11 and chromosome 22. To date, there have been about 100 case reports of supernumerary derivative (22) syndrome. In most of the cases, supernumerary derivative (22) syndrome was the result of 3:1 meiotic segregation in the maternal 11;22 translocation carrier. We now report a case of 47,XX, + der(22)t(11;22)(q23;q11.2) resulting from 3:1 meiotic segregation of the paternal translocation carrier.
Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 22 ; Congenital Abnormalities ; Ear ; Failure to Thrive ; Heart ; Humans ; Intellectual Disability ; Kidney ; Male ; Microcephaly ; Palate ; Parents ; Trisomy

PURPOSE: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. MATERIALS AND METHODS: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. RESULTS: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. CONCLUSION: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.
Arthralgia ; Displacement (Psychology) ; Hallux ; Hallux Valgus ; Humans ; Inflammation ; Metatarsal Bones ; Osteotomy ; Skin ; Sutures

PURPOSE: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. MATERIALS AND METHODS: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. RESULTS: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. CONCLUSION: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.
C-Reactive Protein ; Femur* ; Follow-Up Studies ; Humans ; Operative Time ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) guided intraarticular injection technique comparing to blind technique of the shoulder joint. METHOD: Thirty patients with hemiplegia clinically diagnosed as adhesive capsulitis of the shoulder joint were included. Each patient was treated with serial intraarticular injections with both blind and US guided technique, and then was confirmed by X-ray. We analyzed possible factor including range of motion of the shoulder joint, degree of shoulder subluxation, and clinical stage by Cyriax contributing to failure of intraarticular injection with blind technique. RESULTS: The accuracy of intraarticular injection using blind technique were 46.7% and 33.3% in each physician without significant interpersonal difference. However, US guided intraarticular injection showed the accuracy of 93.3%, significantly higher than blind technique (p<0.05). We could not find significant differences in clinical stage by Cyriax, degree of subluxation between success and failure group by blind technique. However, the range of external and internal rotation of the shoulder joint was more limited in failure group by blind technique (p<0.05). CONCLUSION: Ultrasonography guided injection into the shoulder joint improved the accuracy of injection without exposure to radiation and could be used as one of the promising treatment for patients with adhesive capsulitis of the shoulder.
Bursitis ; Hemiplegia ; Humans ; Injections, Intra-Articular* ; Range of Motion, Articular ; Shoulder Joint ; Shoulder* ; Ultrasonography*

OBJECTIVE: To evaluate the clinical importance of effusion in bicipital tendon sheath and the change of ultrasonographic findings according to the treatment. METHOD: Thirty patients with hemiplegia, clinically diagnosed as adhesive capsulitis in hemiplegic shoulder, were investigated. To confirm the location and existence of effusion and to measure the largest diameter and cross sectional area (CSA) of bicipital tendon sheath, the longitudinal and transverse scan of the shoulder were used. Each patient was treated with a series of three intraarticular injections with triamcinolone under ultrasonographic guidance. After each intraarticular injection, the diameter and CSA of bicipital tendon sheath, and passive range of motion of the affected shoulder were measured and compared to the unaffected side. RESULTS: The initial ultrasonographic examination showed increased amount of effusion in the affected bicipital tendon sheath compared to the unaffected side (p<0.01). After intraarticular injection, the amount of effusion was decreased (p<0.01) and passive range of motion of the shoulder was increased (p<0.05). CONCLUSION: The ultrasonographic evaluation of effusion in the bicipital tendon sheath, and interval change of effusion according to the treatment, can be useful tool for diagnosis and follow-up of adhesive capsulitis in hemiplegic shoulder.
Adhesives* ; Bursitis* ; Diagnosis ; Follow-Up Studies ; Hemiplegia ; Humans ; Injections, Intra-Articular ; Range of Motion, Articular ; Shoulder* ; Tendons ; Triamcinolone ; Ultrasonography

PURPOSE: To evaluate the results of the medial gastrocnemius muscle flap to cover the wound necrosis and dehiscence caused by repeated surgery in the reconstruction of infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Out of forty three reconstructions of infected TKA performed between 1995 and 2002, eleven cases (25.6%)underwent medial gastrocnemius flap to cover the anterior skin defects at the time of reimplantation in two cases and in an average 3.3 weeks after reimplantation in seven cases. Two cases which refused reimplantation were treated by arthrodesis and delayed flap coverage and by flap surgery only resulting in pseudarthrosis respectively. They were five male and six female patients of 61 years (range, 56-77 years)of age in average. Clinical and radiological assessments were done for minimum two years of follow-up. RESULTS: Nine cases (81.8%)maintained TK prostheses with less range of motion (77 degrees in average)than ordinary TKAs of primary healing. Two patients refused TKA which resulted in one arthrodesis and one pseudarthrosis. There was no case of recurrence of wound dehiscence or infection. CONCLUSION: Medial gastrocnemius flap can salvage the prostheses by providing good soft tissue coverage for compromised operative wounds caused by infected TKA and repeated surgical interventions.
Arthrodesis ; Arthroplasty* ; Female ; Follow-Up Studies ; Humans ; Knee* ; Male ; Muscle, Skeletal ; Necrosis ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Recurrence ; Replantation ; Skin ; Wounds and Injuries

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.
Age of Onset ; Ankle ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Blindness ; Classification ; Epidemiologic Studies ; Female ; Hand ; HLA-B27 Antigen ; Humans ; Incidence ; Joints ; Knee ; Male ; Prognosis ; Rheumatoid Factor ; Sex Ratio ; Spondylitis, Ankylosing ; Uveitis

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze natural history and clinical features of scoliosis developed after surgery for congenital heart disease and to investigate the influence of cardiac surgery on the onset and progression of scoliosis. MATERIALS AND METHODS: Three hundred and five patients who had been operated for congenital heart disease from Jan.1988 to Dec.1990 and followed up for more than 5 years were analyzed. The curve which was more than 10 degrees on radiography was defined as significant scoliosis and the patients with congenital spinal anomalies were excluded. We compared age at surgery, cardiac disease and effect of cyanosis between scoliosis and non-scoliosis group. Furthermore, in scoliosis group, prevalence, onset of significant scoliosis, and manifestation of curve according to side of thoracotomy were assessed. RESULTS: Fifty-six patients(18.4%) had scoliosis of more than 10 degrees. As for location, high thoracic in 19, thoracic in 23, double thoracic in 8, thoraco-lumbar in 5 and double major in 1. Of the 42 patients with thoracic or high thoracic curves, 17(40%) showed convexity to the left. The magnitudes of curves were less than 40 degrees except 1. There was no significant difference in prevalence(p=0.513) and Cobb angle(p=0.634) between cyanosis and acyanosis group. Scoliosis developed between 3 and 6 years after cardiac operation in 26 patients(46%). In high thoracic curve, 6 of 7 patients with left thoracotomy demonstrated convexity to the left and 5 of 6 patients with right thoracotomy demonstrated convexity to the right(p=0.026). CONCLUSIONS: The prevalence of scoliosis after surgery for congenital heart disease was 18.4%. High thoracic and left thoracic curves were more frequent compared to idiopathic curves and a half of them developed 3 to 6 years after cardiac surgery. Most patients did not have severe curve to need surgical intervention and there was no correlation between severity of scoliosis and age at cardiac operation and cyanosis. In high thoracic curve, the tendency for the curve to be convex to the side of cardiac approach was demonstrated.
Child* ; Cyanosis ; Heart Defects, Congenital* ; Humans ; Natural History ; Prevalence ; Radiography ; Retrospective Studies ; Scoliosis* ; Thoracic Surgery ; Thoracotomy

PURPOSE: Dispatcher-assisted telephone instruction during cardiopulmonary resuscitation (CPR) improves the quality of CPR performed by laypersons. However, in Korea, CPR instruction guidelines for bystanders have not made. We therefore studied the effects of verbal instruction on the quality of chest compression. METHODS: Data from two randomized, double-blinded, controlled trials using identical methodology were combined to obtain 175 records for analysis. Subjects were randomized into either a "push as hard as you can and fast" (n=87) or "push down 5~6 cm, 100~120 rate/min" (n=88), verbal instructions in the 2011 Korea Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Data were recorded via a Resusci(R) Anne SkillReporter(TM), Laerdal Medical mannequin. Primary outcome measures included chest compression depth and chest compression rate per minute. RESULTS: The average compression depth and speed of chest compressions did not significantly differ between the two verbal instructions. CONCLUSION: The verbal istructions provided by telephone based on the 2011 Korean Guidelines for CPR and ECC are not effective. The instructions for high quality CPR of layperson should therefore be studied.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart Massage ; Korea ; Manikins ; Methods ; Outcome Assessment (Health Care) ; Telephone* ; Thorax ; Verbal Learning