The ankle is an important joint supporting the entire musculoskeletal system during standing and walking. Current opinion has emphasized necessity of anatomical reduction and rigid internal fixation for a displaced or unstable fracture of the ankle. The purpose of this study was to evaluate the correlation of the adequate surgical operative methods and postoperative care with prognosis. The authors analysed 104 cases of ankle fracture, treated operatively in Department of Orthopedic Surgery of Dae-Han Hospital from January 1991 to December 1994, followed up more than one year. The results were as follows: 1. According to the classification of Lauge-Hansen and Danis-Weber, the most common type was supination-external rotation and type B, respectively. 2. The most common cause of injury was slip down and the others were traffic accident, fall down and direct trauma. 3. According to the criteria of Meyer, the result of treatment was good or excellent in 94 cases (90.4%) radiologically and in 91 cases (87.5%) clinically. 4. The complications were 5 cases of traumatic arthritis, 3 cases of malunion, 2 cases of non-union and 1 case of infection. 5. The early ROM exercise after accurate reduction and rigid internal fixation was very important in treatment of fracture of the ankle.
Accidents, Traffic ; Ankle Fractures ; Ankle* ; Arthritis ; Classification ; Joints ; Musculoskeletal System ; Orthopedics ; Postoperative Care ; Prognosis ; Walking

Recently, the incidence of fracture and dislocation of the proximal humerus has been increased with increment of traffic accident and industrial accident. Although most proximal humeral fractures can be treated satisfactorily by simple conservative treatment, the displaced fracture or fracture-dislocatiion of the proximal humerus demands special treatment and judgement. It has been reported that the results of the surgical treatment of the unstable fracture of the proximal humerus was better than that of conservative treatment. The authors analysed 32 cases displaced fracture or fracture-dislocation of the proximal humerus treated operatively which were followed up more than 1 year at the Dae Han Hospital from June, 1990 to May, 1993. The obtained results were as follows; l. According to Neer's classification, there were 2-part fracture in 3 cases(9%), 3-part in 17 cases(54%), 4-part in 2 cases(6%), fracture-dislocation in 8 cases(25%) and head splitting in 2 cases(6%). 2. The clinical results by Neer's criteria were excellent in 9 cases(28%), good in 14 cases(44%), fair in 7 cases(22%), and poor in 2 cases(6%) among the 32 cases. 3. The complication were limitation of motion in 4 cases, avscular necrosis of humeral head in 2 cases, nonunion in 1 case, delayed union in 1 case, ectopic ossification in 1 case and malunion in 1 case. 4. In the unstable fracture of the proximal humerus treated by accurate reduction and rigid fixation with intensive rehabilitation can be obtained, relatively satisfactory results because of the inability to maintain an acceptable closed reduction.
Accidents, Occupational ; Accidents, Traffic ; Classification ; Dislocations ; Head ; Humeral Head ; Humerus ; Incidence ; Necrosis ; Ossification, Heterotopic ; Rehabilitation ; Shoulder Fractures

We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.
Cefotiam* ; Erythema ; Patch Tests ; Tachypnea ; Urticaria*

We herein report a case of transient acrodermatitis enteropathica in a 3-month-old, breast-fed, full-term infant. The patient was presented with a 2-month history of diarrhea and crusted erythema- tous patches on the periorificial area. Similar lesions were seen in his siblings. His serum zinc level and the zinc level in his mother's breast milk were markedly reduced. Diarrhea and skin lesions disappeared promptly with oral zinc supplementation and did not recur when zinc was discontinued after three weeks. Our case indicates that even full-term infants, who feed excl-usively on mothers milk, run a risk of developing zinc deficiency, if the concentration of zinc in the breast milk is very low.
Acrodermatitis* ; Diarrhea ; Humans ; Infant* ; Milk ; Milk, Human ; Mothers ; Siblings ; Skin ; Zinc

PURPOSE: To evaluate value of superparamagnetic iron oxide (SPIO) as a negative oral contrast agent in MR cholangiopancreatography (MRCP). MATERIALS AND METHODS: Forty-eight patients with suspected biliary tract or pancreatic diseases and six healthy volunteers were enrolled in this study. All MR images were obtained using a 1.5 T MR unit. MRCP using fat-suppressed half-Fourier acquisition single-shot turbo spin echo (HASTE) and turbo spin echo (TSE) techniques were performed and reconstructed with maximal intensity projection (MIP). To determine the most optimal concentration of SPIO to obliterate the high signal intensity of water, a phantom experiment was conducted with various concentrations of SPIO-water mixture. Two radiologists evaluated pre- and postcontrast MRCPs. The contrast enhancement was assessed on the basis of loss of signal intensity in the stomach and duodenum. RESULTS: In the phantom experiment, a significant increase of percentage of signal intensity loss (PSIL) occurred in concentration of 22.4 ugFe/ml (Feridex 1 ml diluted with water 500 ml). Postcontrast MRCP showed an improved image quality compared with precontrast images. The rate of improvement in the diagnosis of diseases of the common bile duct and pancreatic duct was 25% (12/48). CONCLUSION: In patients with suspected biliary tract and pancreatic diseases, the SPIO is useful as a negative oral contrast agent for MRCP and provides an improvement of image quality.
Biliary Tract ; Common Bile Duct ; Diagnosis ; Duodenum ; Healthy Volunteers ; Humans ; Iron* ; Pancreatic Diseases ; Pancreatic Ducts ; Stomach ; Water

Lentigo maligna melanoma(LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM evolved from lentigo maligna(LM). A 71-year-old female presented with a longstanding irregular brown patch containing two black papules on the left cheek which developed 8 months ago. Histopathologic findings were consistent with LM and LMM. We performed a wide excision and dufourmental flap for reconstruction with no recurrence for 30 months. Sun exposure has been known as the most important etiologic factor for the development of malignant melanoma including LMM and the incidence has an increasing tendency. Thus, skin biopsy is recommended in the evaluation of a longstanding irregular brown patch on the face to prevent LMM.
Aged ; Biopsy ; Cheek ; Female ; Humans ; Hutchinson's Melanotic Freckle* ; Incidence ; Lentigo* ; Melanoma* ; Recurrence ; Skin ; Solar System

Leriche syndrome is a chronic disorder mostly in male and is a specific symptom complex due to thrombotic obliteration of the aortic bifurcation as result of an atherosclerotic change. The symptoms include 1) extreme liability to fatigue of both lower limbs; 2) symmetric atrophy of both lower limbs; 3) pallor of the legs and feets; 4) inability to maintain stable erection. There are several methods for surgical management of this disorder; 1) thromboendarterectomy with or without sympathectomy; 2) aortoiliac bypass graft; 3) aortofemoral bypass graft. Here we report a case of Leriche syndrome which was successfully managed with aortobifemoral bypass graft with Dacron and reviewed literatures on it briefly.
Atrophy ; Endarterectomy ; Fatigue ; Foot ; Humans ; Leg ; Leriche Syndrome* ; Lower Extremity ; Male ; Pallor ; Polyethylene Terephthalates ; Sympathectomy ; Transplants

BACKGROUND: Although rubella is a mild exanthematous viral infection and its incidence has been greatly decreased after effective vaccination, epidemics of rubella has been noted at 5- to 7-year intervals. But there has been few report about the clinical and histopathologic study of rubella in Korean literatures. OBJECTIVE: The purpose of this study was to review the clinical and histopathologic characteristics of rubella of 1996 outbreak. METHODS: We reviewed the clinical features and histopathologic findings in 50 patients diagnosed as rubella in Department of Dermatology, Presbyterian Medical Center from January 1996 through to May 1996. RESULTS: 1. The male-female ratio was 1: .17. The age distribution was 13-32 years and 72% of patients were aged 16-25 years. 2. Erythematous maculopapular rash on whole body was developed in all patients. Eighty two percent of the patients had fever and lymphadenopathy, and 36% of the patients had petechiae of soft palate. The main prodromal symptoms were sore throat(50%), headache(34%), and upper respiratory symptoms(22%), as order of frequency. 3. Positive serologic test for rubella IgM antibody was 79.5%. 4. The most common abnormal laboratory finding was leukopenia(58%), and followed by positive ASO(34%), the presence of atypical lymphocytes(21%), and thrombocytopenia(8%). 5. Histologically, epidermal changes were mild to moderate vacuolopathy(92.3%), the presence of dyskeratotic cells(30.8%), spongiosis(23.1%), and exocytosis(15.4%). Dermal findings were mild superficial perivascular lymphohistiocytic infiltration(100%), upper dermal edema(53.8%), perivascular edema(38.4%), pigmentary incontinence(30.8%), and the presence of extravasated RBC(23.1%). Eosinophil infiltration(15.4%) and the presence of large nucleated lymphocytes(92.3%) were also observed. Conclusions: According to the results of our study about rubella outbreak in 1996, clinical signs and symptoms were similar to those of previously described. Histologically, superficial perivascular dermatitis with mild to mederate vacuolar interface change was a main feature and large nucleated lymphocytes were frequently noted.
Age Distribution ; Dermatitis ; Dermatology ; Eosinophils ; Exanthema ; Fever ; Humans ; Immunoglobulin M ; Incidence ; Lymphatic Diseases ; Lymphocytes ; Palate, Soft ; Prodromal Symptoms ; Protestantism ; Purpura ; Rubella* ; Serologic Tests ; Vaccination

Occasionally, erythema multiforme has been reported to occur in association with allergic contact dermatitis to various substances including paraquat(Gramoxone(R)). In these cases the erythema multiforme has ranged from mild localized exanthem to life-threatening toxic epidermal necrolysis. We report a case of toxic epidermal necrolysis developed from erythema multiform due to contact of paraquat.
Dermatitis, Allergic Contact ; Erythema ; Erythema Multiforme ; Exanthema ; Paraquat ; Stevens-Johnson Syndrome*

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