PURPOSE: This study was aimed to analyze the incidence and the anatomical distributions of HME (Hereditary Multiple Exostoses) on upper limbs and its related change in alignment of the upper limbs in HME patients. MATERIALS AND METHODS: Thirty eight patients who had been diagnosed HME between 2001 and 2009, were categorized into two groups; (1) group A (1-2 involvements); (2) group B (> or =3 involvements). We checked the carrying angle, VAS (Visual Analogue Scale), limitations in daily activities, cosmetic satisfaction according to the number of exostoses invasion. RESULTS: Among the 38 patients, 23 patients (43 cases) had exostoses in the upper limbs. The locations of exostoses in the upper limbs were proximal humerus in 33 cases (30%), distal ulna in 31 cases (28.2%), and distal radius in 24 cases (21.8%). The carrying angle of group A and B was 10.7degrees, 13.8degrees, VAS was 1.3, 3.5, and the limitations in daily activities was 7.3, 6.6 of 8 points. The cosmetic satisfactory cases were 13 and 10 cases, respectively. CONCLUSION: The deformity in upper limbs was observed in 65% of the HME patients. As the number of invasion increases, carrying angle and VAS were increased but limitations in daily activities and cosmetic satisfaction were decreased.
Congenital Abnormalities ; Cosmetics ; Exostoses ; Exostoses, Multiple Hereditary ; Humans ; Humerus ; Incidence ; Lifting ; Radius ; Ulna ; Upper Extremity

CT scans of 21 patients(intrathoracic goiter=7. Castleman disease=6, pulmonary carcinoid tumor=3, parathyroid adenoma=1, thyroid carcinoma=1, paraganglioma=1, benign pleural mesothelioma=1, sclerosing hemangioma=1) with mediastinal tumors that are known to be enhanced with intravenous injection of contrast media, were studied retrospectively to investigate the enhancing capabilities f those tumors and to describe their CT findings. The degree of enhancement was estimated by visual inspection with a grading system. All but one case of cystic parathyroid adenoma showed enhancement on post-contrast scan. The degree of enhancement was not helpful in differentiating these tumors. Characteristic location and pattern of tumor extension were found in cases of intrathoracic goiter, parathyroid adenoma, thyroid carcinoma and paraganglioma. Calcifications were found in intrathoracic goiter(5/7). Castleman disease(2/6). Pulmonary carcinoid(1/3), thyroid carcinoma. Necrotic low-attenuation areas were in intrathoracic goiter(7/7), parathyroid adenoma, thyroid carcinoma and paraganglioma. In conclusion, mediastinal tumors that are known to be enhanced in the literature were enhanced with rare exception, and if we consider the predilection site of those tumors, the scope of differential diagnosis can reasonably be narrowed.
Carcinoid Tumor ; Contrast Media ; Diagnosis, Differential ; Goiter, Substernal ; Injections, Intravenous ; Paraganglioma ; Parathyroid Neoplasms ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Tomography, X-Ray Computed

Total hip replacement for adults with severe acetabular dysplasia presents a difficult problem because deficient bone stock and soft tissue contractures usually prevent sitting at the normal anatomic level. The rationales of high hip center are due to high failure rate of bulk structural weight bearing graft, good short-term result of hemispherical cementless acetabular component in revision surgery, high hip center but not lateral which does not adversely affect the biomechanics of the hip, and intimate apposition with viable host bone. We represented the short-term results of 21 total hip replacements with proximal placement of the acetabular cup than the anatomical position that is normally used. The mean duration of follow up was 18 months(range, 12-58 months) and the mean age of the patient was fifty-one years(range, thirty to sixty-seven years). Most of these hips had a major deficiency or defect of the acetabular bone stock. They had an aver- age Harris hip score of 47 points preoperatively and 90 points postoperatively. Roentgenographic measurements showed that the mean change in the height of the center of the hip postoperatively was only +6.6 millimeters and the mean change of horizontal location of them was 10 millimeters medial to the preoperative position. Postoperative complications included calcar fracture(1 case), trochanteric bursitis(1 case), postop- erative dislocation(1 case) and one case of radiological loosening of the acetabular component. The center of the hip in THR is not a crucial parameter with regard to the long-term stability of acetabular component, so our recommendation is to place the acetabular component at a more proximal but not lateral position if strong bone stock is available. But future studies of high hip center need to address femoral component longevity.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Contracture ; Femur ; Follow-Up Studies ; Hip Joint ; Hip ; Humans ; Longevity ; Osteoarthritis ; Postoperative Complications ; Transplants ; Weight-Bearing

The ankle impingement syndrome is an established cause of ankle dysfunction. In most cases with suspected ankle impingement, the diagnosis can be possible on the basis of mechanism of injury involved and the clinical examination. An appropriate imaging study should be selected where clinical doubt about the exact diagnosis exists. Radiography plays an important role in the initial assessment of these conditions, especially in anterior and posterior impingement. Magnetic resonance arthrography seems to be the most accurate means of assessing the capsular abnormalities present in anterolateral and anteromedial impingement and for confirmation of possible concomitant injury. Surgical treatment can be considered for the patients who did not respond to conservative treatment for more than 6 months, and has a low complication rate and a high level of success.
Animals ; Ankle ; Arthrography ; Humans ; Magnetic Resonance Spectroscopy

Although first generation total ankle replacement (TAR) had high failure rates, recent investigations have reported good results of the newer generations of TAR due to advances in implant designs and techniques. Patient selection is critical to performing TAR to obtain promising outcomes and to decrease complication rate. As the current concepts of correcting the accompanying deformity have been established, TAR in moderate to severe varus deformity of the ankle result in favorable outcomes and indications for TAR are expanding. Correction of deformity and hindfoot fusion should be performed in conjunction with TAR if needed. If radiolucency around components or osteolysis is progressive during follow-up, CT should be carried out as a confirmative diagnostic method. TAR is an effective treatment modality alternative to ankle fusion. However, we should recognize that TAR is a demanding procedure, which requires accurate techniques, enough experience, and preoperative plan for a concomitant deformity.
Animals ; Ankle ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Congenital Abnormalities ; Family Characteristics ; Follow-Up Studies ; Osteolysis ; Patient Selection

No abstract available.
Rhinoplasty*

BACKGROUND: Cystic neoplasms of the pancreas are rare tumors that constitute about 10% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. This study was conducted to investigate the diagnostic accuracy and postoperative results for these rare tumors. METHODS: The authors reviewed retrospectively 7 patients with cystic neoplasms of the pancreas who had been treated surgically in the period from 1986 through 1998 at the Department of Surgery, Paik Hospital, Seoul. RESULTS: There were 3 serous cystadenomas, 3 mucinous cystadenomas, and 1 papillary and cystic neoplasm. All 7 patients were women. The mean age of the patients was 36.7 years, 45 years for the serous tumors and 37 for the mucinous tumors. Two patient had diabetes mellitus. Major symptoms were abdominal pain (71%) and an abdominal mass (29%). One patient with a mucinous cystadenoma presented with bleeding from gastric varix which developed as a consequence of a splenic vein obstruction by the tumor. The positive rate for CEA was 33.3%, and that for CA 19-9 was 50.0%. No patient showed an abnormally elevated serum amylase level. Computed tomography was helpful in differentiating cystic tumors from pseudocysts or adenocarcinomas of the pancreas. The sites of the lesions were the tail in 3 cases, the body in 2cases, and the head in 2 cases. A distal pancreatectomy was performed in 5 cases, a pylorus-preserving pancreatoduodenectomy in 1 case, and enucleation of the cyst in 1 case. All the patients were alive at 3 to 145 months postoperatively and showed no evidence of disease. CONCLUSION: We conclude that the prognosis for resected cystic neoplasms of the pancreae is good. The correct preoperative differential diagnosis of pancreatic cystic lesions is important for planning the appropriate management, even though the clinical and the radiological features of these lesions are not always reliable.
Abdominal Pain ; Adenocarcinoma ; Amylases ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Diabetes Mellitus ; Diagnosis, Differential ; Esophageal and Gastric Varices ; Female ; Head ; Hemorrhage ; Humans ; Mucins ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies ; Seoul ; Splenic Vein

PURPOSE: Attention Deficit Hyperactivity Disorder (ADHD) is known to be more common in children with epilepsy than in the general population. Thirty one to forty percent of ADHD is accompanied with epilepsy. Few studies regarding this matter have been reported in Korea. This study was aimed to evaluate the comorbidity of ADHD in children with epilepsy. METHODS: This is a two center based, retrospective and controlled study. Thirty four ADHD children with epilepsy from Chungbuk National University hospital and 38 ADHD children without epilepsy from Cheonju St. Mary's hospital were recruited from January 2005 to June 2010. RESULTS: In ADHD children with epilepsy, twelve (35.2%) had partial seizures, 11 (32.2%) did generalized seizures and 11 (32.2%) were unclassified. EEG abnormalities were found in the frontal lobe (15 cases), in the central lobe (7 cases), in the temporal lobe (6 cases), and in the occipital lobe (3 cases). In ADHD children with epilepsy, the combined type was major (76.4%) and in ADHD children without epilepsy, the inattentive type was major (50.5%) (P=0.004). Learning disability was mor common in ADHD with epilepsy than in ADHD without epilepsy (P=0.01). CONCLUSION: This study showed that ADHD children with epilepsy are more likely to have combined type (76.4%) and learning disability as compared with ADHD without epilepsy.
Attention Deficit Disorder with Hyperactivity ; Child ; Comorbidity ; Electroencephalography ; Epilepsy ; Frontal Lobe ; Humans ; Korea ; Learning Disorders ; Occipital Lobe ; Retrospective Studies ; Seizures ; Temporal Lobe

BACKGROUND: Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes. We evaluated the severity of bronchial mucosal damage by bronchial cuff pressure in Robertshaw double-lumen endobronchial tubes. METHODS: Eighteen patients were divided into two groups: in group 1(n=9), bronchial cuff pressure was maintained by 25 mmHg; in group 2(n=9), bronchial cuff pressure was maintained by 35 mmHg during one-lung ventilation. We evaluated the bronchial mucosa by using fiberoptic bronchoscopy before bronchial intubation and following extubation. According to the number of petechia and mucosal hemorrage or tearing, damage scoring was performed. RESULTS: Damage scores of Group 1 are represented by 0(normal mucosa) in number of 3 patients, 1 (small number of petechia) in 2 patients, 2 (large number of petechia) in 3 patients, 3 (mucosal hemorrhage) in 1 patient and above score 4 (mucosal tearing) was not existed. Scores of Group 2 are represented by 0 in number of 1 patient, 1 in 3 patients, 2 in 4 patients, 3 in 1 patient and above score 4 was not existed. CONCLUSION: Degree of bronchial mucosal damage was not related with the bronchial cuff pressure of double lumen tubes.
Bronchoscopy ; Humans ; Intubation ; Lung ; Mucous Membrane ; One-Lung Ventilation ; Respiratory Mucosa ; Rupture

We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture).
Aged ; Anti-Bacterial Agents ; Cellulitis* ; Drainage* ; Endoscopy, Digestive System ; Esophagitis* ; Esophagus ; Female ; Humans ; Jejunostomy* ; Suppuration